oral cavity

Question 1

genetic changes associated with “classic” head/neck SCC, and “HPV” head/neck SCC

Answer 1

classic:
P53 mutation

HPV:
p16 overexpression
E6 inactivation (p53)
E7 inactivation (RB)

Question 2

oral manifestation of measles

Answer 2

-spotty oral ulcers preceding skin rash
-buccal ulcers about stensen duct (parotid duct)
(buccal ulcer = KOPLIK SPOTS)

Question 3

____ is sticky colorless biofilm that collects between/on teeth made of bacteria, proteins, desquamated epithelial cells, and if untreated leads to ______, tartar

Answer 3

plaque —> calculus (mineralized plaque)

Question 4

what are the 3 types of oral candidiasis

Answer 4

1. psuedomembranous (thrush) *most common
2. erythematous
3. hyperplastic

Question 5

define acute herpetic gingivostomatitis

Answer 5

children (2-4 yo) with HSV1/2 are usually asymptomatic, but if this disease presents with sx they are:
rapid onset of oral mucosa ulcerations and adenopathy with fever, anorexia, and irritability

Question 6

inflammation of the oral mucosa (gums) around the teeth due to development of DENTAL PLAQUES and CALCULUS (and is reversible)

Answer 6

gingivitis

sx: red gums, edema, bleeding, mucosa contour changes

Question 7

oral manifestation erythema multiform

Answer 7

-maculopapular, vesiculobullous, eruption

due to underlying infection, drug, cancer

Question 8

inflammation affecting periodontal Ligaments (teeth support structures), alveolar bone, and cementum

Answer 8

periodontitis

Question 9

oral manifestation diphtheria

Answer 9

dirty, white, fibrinosupprative, tough, inflammatory membrane over tonsils and retopharynx (throat)

{WHITE INFLAMMATORY MEMBRANE ON THROAT)

Question 10

define odontogenic keratocyst (OKC)

including X-ray and histological characteristics

Answer 10

• aka keratocystic odontogenic tumor
• cysts derived from remnants of odontogenic epithelium within the jaw
• aggressive tumor
• x-ray: well defined locular radioluciences
• histo: thin layer of keratinized stratified squamous epithelium with prominent basal cell layer and corrugated epithelial surface
• tx: removal

Question 11

very PAINFUL superficial oral mucosa ulcerations (recurrent and common) characterized by one or more hyperemic ulcers covered by thin exudate with red rim

Answer 11

apthous ulcers (canker sores)

• most common from 1-20 yo
• most resolve in 1 week unless immunocompromised

Question 12

define recurrent herpetic gingivostomatitis

Answer 12

most adults harbor HSV 1 and get this dz.

• occurs at site of inoculation or in adjacent mucosa associated with same ganglion with dormant virus
• group of small vesicle lesions on lips (herpes labialis), nasal, cheek mucosa, and hard palate
• subside in 1 week or longer if immunocompromised

Question 13

define pyogenic granuloma

Answer 13

[type of fibrous proliferative lesions]

• not pyogenic or granuloma**
• aka pregnancy tumor
• lobular capillary hemangioma that presents with ulcerated red-purple (NOT NODULAR) lesions on gingiva (gums)
• can progress to become dense fibrous masses or peripheral ossifying fibroma
• tx: removal

Question 14

where does HSV 1/2 infection lay dormant

Answer 14

trigeminal (semilunar) ganglion

Question 15

KEY sx assoc with deep fungal infections of oral cavity (esp mucormycosis)

Answer 15

-unilateral facial swelling, nasal/oral black lesions

more but less important sx: HA, fever, nasal congestion

Question 16

benign painless bony outgrowth on the hard palate

Answer 16

torus palatinus
(type of oral extoses)
*grow due to genetics and environment

Question 17

oral manifestation of scarlet fever

Answer 17

• raspberry tongue (red with prominent papillae)
• strawberry tongue (white with visible herpermic papillae)

(others: rash (impetigo) , sore throat, high fever,)
(cause is group A strep pyrogenes)

Question 18

why is early detection important in head neck SCC

Answer 18

because 2nd primary tumor is most common cause of death in this type of SCC

Question 19

benign bony growth in the mandible along surface near the tongue (in mouth)

Answer 19

torus mandibularis
(type of oral extoses)
*no cartilage
*grow due to genetics and environment

Question 20

focal demineralization of tooth structure (enamel/dentin) by acid metabolites of bacteria produced fermented sugars

Answer 20

caries (tooth decay)

Question 21

what are Hutchinson teeth and what pathology are they associated with

Answer 21

notched incisor teeth characteristic of congenital symphilis

Question 22

what is the next step if multiple odontogenic keratocysts are seen in a patient

Answer 22

• must evaluate for Gorlin syndrome (nevoid basal cell carcinoma syndrome)
• associated with PTCH mutation on chr 9q22

Question 23

“field cancerization: of head/neck SCC is associated with

Answer 23

cigarette smoking and repeated carcinogenic exposure

Question 24

what pathogen is responsible for oral candidacies (thrush)

Answer 24

candida albicans

Question 25

oral manifestation HIV

Answer 25

-increased risk of oppuruntistic infections (HSV, Candida, Fungi) -oral lesions of Kapoi Sarcoma -hairy leukoplakia

Question 26

three types of fibrous proliferative lesions of the oral cavity

Answer 26

1. irritation fibroma 2. pyogenic granuloma 3. peripheral ossifying fibroma * *tx for all is removal

Question 27

define leukoplakia

Answer 27

white plaque that CANNOT be scraped off and CANNOT be tied to other dz -precancerous lesion of squamous cell carcinoma (*thrush CAN be scraped off and due to candida)

Question 28

define peripheral ossifying fibroma

Answer 28

[type of fibrous prolifertive lesions] - reactive lesion derived from pyogenic granuloma or denovo of periodontal L. - present as red ulcerated NODULAR lesions of ginvgivia (gums) - common in teenage girls - tx: remove down to periosteum

Question 29

biggest risk factors for lower lip cancers

Answer 29

pipe smoking and actinic radiation (sunlight)

Question 30

***COLON QUESTION*** | volcanic crypt eruptions is histo dx for what colonic pathogen

Answer 30

c. diff | pseudomembranes are not specific to only c. diff

Question 31

oral manifestation of mono

Answer 31

- acute pharyngitis/tonsilittis with gray white exudative coat - neck LN enlargement - palatal petechiae

Question 32

oral manifestation of SLE

Answer 32

-small PAINLESS oral/ nasopharyngeal ulcers (others: butterfly rash, pancytopenia, arthralgia, nephritic syndrome) [skin rash, joints, kidneys]

Question 33

biggest risk factor of squamous cell carcinoma of head and neck

Answer 33

``` alcohol and tobacco use (others = - chewing betel quid and paan -actinic radiation (sunlight) -pipe smoking) *last two = lower lip cancers ```

Question 34

define hairy leukoplakia

Answer 34

- oral lesions = white, confluent, fluffy patches of hyperkeratotitic thickenings - oral lesion on LATERAL border of tongue - HYPERPLASIA (not dysplasia as seen in NL leukoplakia and erythroplakia ) - seen in EBV infection of immunocompromised patients (esp HIV) - microscopically= hyperkeratinosis, acanthosis, and "BALLOON CELLS" in upper spinous layer

Question 35

normal healthy oral flora contains? unhealthy?

Answer 35

NL: facultative gram positive organisms ABNL oral flora in plaque: anaerobic microaerophilic gram negative organisms

Question 36

define the characteristics of HSV vesicles in recurrent herpetic gingivostomatitis

Answer 36

* have EOSINOPHILIC INTRANUCLEAR VIRAL INCLUSIONS * have fusion cells that make MULTINUCLEATE POLKARYONS (giant cells) * giant cells cause + Tzanck test

Question 37

common bacterial pathogens that cause periodontitis

Answer 37

* PAP - actinobacilius actinomycetemocomitans - porphyromanos gingivalis - prevotella intermedia

Question 38

factors affecting risk fo oral candidiasis

Answer 38

immune status, strain of candida, composition of oral flora

Question 39

describe the appearance of psuedomembranous oral candidiasis

Answer 39

gray white inflammatory membrane of organisms in fibrinosupprative exudate with underlying erythematous base * *superficial infection unless immunocompromised (cancer pts, organ transplant pts, chemo tx pts) * *THE MEMBRANE CAN BE SCRAPED OFF therefore distinguishable from leukoplakia

Question 40

erythroplakia vs leukoplakia

Answer 40

more severe dysplasia and higher risk of malignant transformation in erythoplakia vs leukoplakia *when both are present it is called speckled leukoerythroplakia

Question 41

what organisms are responsible for deep in fungal infections of the oral cavity

Answer 41

1. aspergillosis 2. cryptococcis 3. mucormycosis !! predisposing RF: immunocompromised -are highly vascular invasive -sx: unilateral face swelling, nasal/mouth black lesions, HA fever, nasal congestion

Question 42

population assoc with erythroplakia

Answer 42

40-70 yo male with hx of tobacco use | risk of squamous cell carcinoma of head and neck

Question 43

define irritation fibroma

Answer 43

[type of fibrous proliferative lesion] - aka trauma fibroma or focal fibrous hyperplasia - submucosal nodular mass of fibrous connective tissue that most commonly occurs on the buccal (cheek) mucosa along the bite line - tx: removal

Question 44

define erythroplakia

Answer 44

red, velvety, possibly eroded areas of oral cavity that are usually level or slightly depressed -precancerous lesion (common in 40-70 men with hx of tobacco use)

Question 45

complications, pathogenesis, and Risk factors associated with periodontitis

Answer 45

complication : teeth loss pathogensis: poor oral hygiene + oral flora change RF: neutrophil defect, Crohns, leukemia, AIDS, Down syndrome, Diabetes, sarcoidosis (NC LADDS) *can be component of systemic dz, or cause systemic dz (endocarditis, pulmonary or brain abscesses)

Question 46

pathogen associated with squamous cell carcinoma of head and neck (esp tonsils, base of tongue, pharynx)

Answer 46

HPV-16 | OROPHARYNX SCC

Question 47

prognosis of head and neck SCC

Answer 47

if HPV + SCC then better long term survival vs "classic" SCC (classic SCC = alcohol and tobacco assoc; NOT HPV assoc)