Midterm Flashcards

Question

11. Fissured Tongue

Answer 1

* Numerous grooves or fissures on the dorsal tongue, 2-6 mm deep. * Cause ??? Heredity? * 2 - 5% of the population, increasing with age * Mild burning or soreness sometimes * Treatment - Brush the tongue

Answer 2

* “Erythema Areata Migrans”, “Benign Migratory Glossitis” * 1 - 3% of the population, 2F>1M * Dorsal tongue, rarely ventral * Asymptomatic with rare cases of sensitivity to hot or spicy foods * No treatment

Answer 3

* Denture papillomatosis * 20% of the patients who wear their dentures 24 hours a day * Hard palate, pebbly surface * Asymptomatic

Answer 4

• Treatment - surgical excision (scapel, electro-, cryo-, laser-surgery) then reline or remake of the denture

Answer 5

Recurrent Herpes Simplex • Almost ALWAYS on keratinized, bound mucosa (palate, attached gingiva) • Symptoms are less intense • Lesions begin as 1-3 mm vesicles – Rapidly collapse to form a cluster of erythematous macules that coalesce and slightly enlarged – Damaged epithelium is lost – Central, yellowish area of ulceration – Heals in 7-10d * Acute herpetic gingivostomatitis: Initial exposure between 6 months - 5 years of age * Recurrent herpetic infections: herpes labialis, intraoral recurrent lesions, herpetic whitlow, herpetic keratoconjunctivitis

Answer 6

* Acyclovir 5% ointment (Zovirax), 15 gm tube, apply 5 times a day with fingercot at first symptom * Acyclovir 200mg. capsules, dispense 50, 1 cap 5 x daily * Famciclovir (Famvir) 125 mg tablets, bid for 5 days. * Penciclovir 1% (Denavir) Cream, 2 gm tube, apply q2h. * Prodromal stages is best time to start treatment (Use VIROXYN) * Prophylaxis: Lysine 500 mg tab. QD

Answer 7

* Rupture & spillage of saliva into the soft tissues * Young adults, trauma related * Lower lip - most common location * Treatment - Surgical excision along with the feeder gland

Answer 8

* Post trauma locations * Post surgical locations * Treatment - none

Answer 9

• Causes: Reduced vertical dimension, salivary pooling, candidiasis

Answer 10

• Treatment: antifungals, increase the vertical dimension

Answer 11

* Lymphoid hyperplasia on the posterior lateral borders of the tongue, bilateral * Discrete 1 cm masses which enlarge and turn red with infection * Treatment: none

Answer 12

* Accumulation of blood within the tissues secondary to trauma * Treatment: none

Answer 13

• Soft, fissured gray-white lesion of the mucosa located in the area of chronic snuff placement • Histologic appearance varies based upon duration • Treatment: Cessation of “dipping” If use continues, results may progress from Dysplasia to Verrucous Carcinoma (cauliflower)

Answer 14

* Morsicatio buccarum, labiorum, linguarum * 2F:1M * Irregular ragged white mucosa * Treatment: none or bite guard

Answer 15

Oral lichen planus must be differentiated from lichenoid drug reactions, and there are dozens of drugs that can cause it. • Chronic mucocutaneous disease • Middle aged, 3F:2M • Skin lesions: purple, pruritic, polygonal papules • Oral lesions: Reticular (Striae of Wickham), Erosive

Answer 16

Reticular and Erosive

Answer 17

• Treatment: Steroids • Aphthasol 5%, 5 gm tube, apply to ulcer • Betamethasone (Celestone) Syrup, dispense 8 oz., 1 tsp qid, gargle & expectorate. • Temovate .05% ointment, 15 tube • Decadron Elixir 0.5mg/5ml, Rinse & expectorate. • Lidex 0.05% ointment or gel • Medrol Dose pack

Answer 18

* Bony protuberances on the buccal of the mandible and/or maxilla * Treatment: Removal only with chronic repeated trauma or preprosthetic surgery

Answer 19

* Implantation of dental amalgam into oral soft or hard tissue * Black, blue or grey in soft tissue tattoos * May be radiopaque * Treatment: none, however biopsy may be necessary to rule out melanoma

Answer 20

``` • Focal Melanosis (“oral freckle”) • Solitary well-demarcated tan to dark brown macule, 1-7 mm • 2F:1M • Lower lip > buccal mucosa > gingiva • Treatment: none, however biopsy may be indicated to rule out melanoma ```

Answer 21

* Central papillary atrophy of the tongue | * Asymptomatic erythematous zone in the midline posterior dorsal tongue

Answer 22

• Treatment: antifungals and brushing of the tongue

Answer 23

Condition is usually asymptomatic, but occasional patients complain of: Gagging sensation, Bad taste, Halitosis, Esthetics

Answer 24

* Causes: Pernicious anemia, Medications, Avitaminosis * Symptoms: burning and pain * Treatment: find the underlying cause and stop it

Answer 25

* Skin cysts associated with inflammation of a hair follicle • Oral cysts occur in the midline of the floor of the mouth • Slow growing, painless, rubbery mass * Treatment: Surgical removal

Answer 26

* Benign tumor of fat * Skin lesions: trunk and proximal portions of the extremities * Oral lesions: buccal mucosa > tongue > floor of the mouth > lips * Yellowish soft nodular mass * Treatment: Surgical excision

Answer 27

``` Thickened epithelial covering - Hyperkeratosis, acanthosis, dysplasia, carcinoma Decreased vascularity - Anemia Increased collagen - Submucous fibrosis ```

Answer 28

1. Size 2. Morphology 3. Location 4. Texture 5. Color - A fibroma is a 2 mm sessile nodule on buccal mucosa, smooth surfaced, and pink in color

Answer 29

Thinner epithelium Increased vascularity A dissolution of the collagen content of the subepithelial tissue

Answer 30

Localized spongiotic gingival hyperplasia

Answer 31

Venous blood collection as opposed to the red of arterial blood collection Tyndall effect Medications

Answer 32

Melanin: a pigment produced by cells called melanocytes, acts as a sunscreen and protects the skin from ultraviolet light Heavy metals: amalgam, iron, bismuth

Answer 33

Melanin | Hemosiderin: a yellowish brown granular pigment formed by the breakdown of hemoglobin, found in phagocytes

Answer 34

Adipose tissue Sebaceous material (skin oil) as noted in fordyce granules Pus as it is a collection of necrotic material, PMNs, and lymphocytes

Answer 35

Most to Least: 1. White 2. Red 3. Black 4. Blue and Yellow (Tie)

Answer 36

First thing you do is try and rub it off, if it does come off, then it is probably one of those five things. If it doesn't, than could be leukoplakia. Remove obvious frictional causes, and biopsy after two weeks

Answer 37

Desquamative gingivitis. The differentials are mucous membrane pemphigoid, pemphigus, allergies, and rarely SLE. - Biopsy for confirmation, and then you can use topical steroids.

Answer 38

Ask them if they have itchy skin lesions on rest of body. If they do, that's not psoriasis.

Answer 39

Topical steroid application. He likes Clobetasol Propionate Gel (Temovate) 0.05%. 15 or 30 gram tube. Have them dry the infected area, gently massage a thin amount two to three times a day.

Answer 40

Pastes and creams are more for skin, gel more for mouth. Paste is an option for the mouth but cream is not. If all over the mouth, use a rinse instead of a gel, or if it is on the soft palate.

Answer 41

Fluocinonide (Lidex) - 0.05% gel - 15 or 30 gram tube - Dry the affected area and gently apply a thin amount 2-4 times daily, depending on how bad it is. - Has moderate potency (not yet proven with FDA) Clobetasol Proprionate (Temovate) - 0.05% gel - 15 or 30 gram tube - Dry the affected area and gently apply a thin amount 2-3 times daily - Has high potency Dexamethasone Elixir (Decadron) (Is a Rinse) - 0.5mg/5ml - 12-16 oz (about 500 ml or .5 liters) - Rinse with 1 tsp. for 2 minutes 2-4 times daily and expectorate - Has moderate potency - Tell them that it is a solution and you want 0.5mg/5mL - Give them enough to give them a few months of comfort, but then they will get back in to get more. -For a rinse, he does 3 refills, for Temovate he only does 1

Answer 42

1. Leukoplakia - Biopsy 2. Linea Alba - Nothing 3. Leukoedema - Nothing 4. Chronic Cheek Chewing - Bite Guard 5. Nicotine Stomatitis - Discontinue 6. Tobacco Pouch Keratosis - Discontinue 7. Lichen Planus - Steroids 8. Oral Hairy Leukoplakia - Treat AIDS

Answer 43

Aphthasol Dexamethasone Temovate (Clobetasol Proprionate) Lidex

Answer 44

``` Intra-lesional injections. Kenalog 10 (10 mg/ml) Kenalog 40 (40 mg/ml) - 1 ml for every 1 cm of tissue - 10 mg per cm of lesional tissue - 1 ml of Kenalog 10 or 0.25 ml of Kenalog 40 ```

Answer 45

``` White pseudomembranous Erythematous - Central papillary atrophy of tongue (Median Rhomboid Glossitis - Angular Cheilitis - Denture Stomatitis ```

Answer 46

1. Rinse 2. Troche 3. Tablet 4. Cream/ointment

Answer 47

Mycolog II - 0.1% Triamcinolone and Nystatin 100,000 units/gram ointment. - in 15 gram tube, - used sparingly to affected areas qid (There is also just a nystatin ointment that is dispensed the same way)

Answer 48

Nystatin (Mycostatin) oral suspension (100,000 units/ml) - Dispense 180 ml - Rinse with 1-2 tsp for 3-4 minutes qid and expectorate, unless affecting soft pharynx, then swallow - Remember not to use the rinse with dry mouth or severe caries because this has sugar. Use Clotrimazole (Mycelex) troche in this case.

Answer 49

Clotrimazole (Mycelex) Troche 10 mg - This is used when patients hate the rinse - Dispense 50 - Dissolve one troche 5 times a day. Let it dissolve in mouth

Answer 50

False, neither does petechiae. Hemangiomas will blanch under pressure though. And you treat them with surgery, laser, or observation.

Answer 51

Floor of mouth, tongue, and soft palate | - 90% are histologically severe dysplasia, Ca in situ, or squamous cell carcinoma

Answer 52

``` Acquired pigmentation Reactive process due to trauma Seen almost always in blacks Most common in females in 20 to 30s Buccal mucosa Lesions increase rapidly in size Incisional biopsy to rule out melanoma ```

Answer 53

1. Erythematous candidiasis 2. Angular cheilitis 3. Lingual tonsil 4. Hemangioma 5. Hypersensitivity reaction 6. Erythroplakia

Answer 54

1. Racial pigmentation 2. Amalgam Tattoo 3. Oral melanotic macule 4. Intramucosal nevus 5. Oral Melanoacanthoma 6. Malignant Melanoma

Answer 55

1. Blue nevus 2. Varicosities 3. Hemangioma 4. Mucocele/Ranula 5. Salivary duct cyst 6. Mucoepidermoid carcinoma

Answer 56

Benign soft tissue neoplasm that shows a predilection for the oral cavity Most common site is the tongue (up to 50%) – Dorsal surface Asymptomatic, sessile nodule that is less than 2 cm May be yellow or mucosal-colored African American patients may experience multiple tumors

Answer 57

1. Fordyce granules 2. Lymphoid hyperplasia (lingual tonsil) 3. Gum boil (Parulis) 4. Lipoma 5. Granular Cell Tumor

Answer 58

Anti-depressants, beta blockers, sleeping aids

Answer 59

Xerostomia

Answer 60

1. Sip water throughout the day 2. Suck on ice (do not chew) 3. Discontinue alcohol, caffeine, soda 4. Humidifier at night 5. Lubricate lips (lanolin) 6. Fluoride supplementation

Answer 61

PIlocarpine (Salagen) - 5 mg tablets - Dispense 90 tablets - 5 mg three times a day for first month, and then titrating to maximum dose of 30 mg per day depending upon response and tolerance - Approved for tx of dry mouth from radiation/chemotherapy. Sjogren's Syndrome - Medications with anticholinergic effects counteract - Benadryl, some antidepressants - Biggest side effect is sweating

Answer 62

1. Chapstick 2. Aquaphor 3. Blistex complete 4. Lanolin

Answer 63

Acyclovir (Zovirax) - Caps and ointment - 200 mg, dispense 50, 1 cap 5 times a day - 5% ointment, dispense 15 gram tube, apply to affected area 5 times a day with fingercot Famciclovir (Famvir) - 125 mg tablets - Dispense 10 tablets, take 1 tablet twice daily for five days

Answer 64

1. Lubrication 2. Candidiasis treatment 3. Nutritional treatment (B12, folate, iron, zinc) 4. Diabetic control 5. Eliminate triclosan/tarter control products 6. Switch hypertensive medication if on ACE-inhibitor 7. Clonazepan 0.5 mg tablet. Start with dissolving half a 0.5 mg tab twice daily and slowly increase to 1 mg twice a day 8. Alpha Lipoic Acid 9. Capsaicin

Answer 65

* Mustbedatedandsignedondayofissue * Patient’sfullnameandaddress * Practitioner’sfullnameandaddressandDEA# * Drugname * Strength * Dosageform * Quantityprescribed * Directionsforuse * Numberofrefills(ifany) * Writteninink,indeliblepencil,ortypewritten * Manually signed Schedule II controlled substances • Requirewrittenprescription • Nofederaltimelimittofill • Nospecificfederallimitstoquantities(somestatesand insurance carriers limit to 30-days) • Refillsprohibited • Multipleprescriptions(90days)permitted(conditions exist) • Facsimile(fax)prescriptionsokforpreparationonly (original must be presented for dispensing) • Emergencyphoneprescriptiononlyforquantitytocover emergency period provided original prescription received within seven days

Answer 66

hydrocodone products like Vicodin & Norco oxycodone (OxyContin®, Percocet®), and fentanyl (Sublimaze®, Duragesic®).

Answer 67

Superscription—patient’s name,address, date and Rx (recipe)

Answer 68

name of drug, dose form, and quan0ty

Answer 69

directions to pharmacist

Answer 70

directions to patient

Answer 71

Heading—name and address and phone # prescriber --name and address of the patient --date of prescription Body—Rx symbol --name, form (tablet) and dosage size or concentration of drug --amount or quantity --directions to patient --"Disp: 20 tabs" --"Sig: 1 tab q4h prn pain"

Answer 72

For autoimmune or vesicular bolus, pemphigoid, pemphigus, lichen planus after gel proved not to work. This is systemic. Prednisone 10 mg tab Disp: 40 Sig: 2 tabs bid x 7d, then 1 tab bid x 4d, then 1 tab daily til gone

Answer 73

Xylocaine Viscous 2% Disp: 100ml sig: Rinse with 1 tsp as needed and spit out Magic Mouthwash -Equal parts maalox, benadryl, and xylocaine viscous 2%. This will help soothe and numb the mouth.

Answer 74

Mycostatin

Answer 75

Mycolog II

Answer 76

• Treatment: Steroids • Aphthasol 5%, 5 gm tube, apply to ulcer • Betamethasone (Celestone) Syrup, dispense 8 oz., 1 tsp qid, gargle & expectorate. • Temovate .05% ointment, 15 or 30 gm tube • Decadron Elixir 0.5mg/5ml, Rinse & expectorate. • Lidex 0.05% ointment or gel • Medrol Dose pack 1. You can use Aphthasol 5%, 5 gm tube, apply to ulcer 2. (High Potency Topical Corticosteroid) - Fluocinonide 0.05% (Lidex). Dispense 15 gm tube. Apply sparingly to affected areas qid. 3. Dexamethasone Elixir 0.05mg/5ml (Decadron) - Dispense two 100 ml bottles. Rinse with 1 tsp for 3-4 min after meals and at bedtime and spit out 4. (Highest Potency) - Clobetasol Propionate 0.05% Gel (Temovate). Suspense 15 g tube. Have them dry the infected area, gently massage a thin amount two to three times a day. - And if gel is not working, use Prednisone (systemic) 10 mg tablets. Dispense 40 tablets. Sig: 2 tabs bid for 7 days, then 1 tab bid for 4 days, then 1 tab daily til gone.

Midterm Flashcards

(131 cards)