Oral Cavity Path II

Question 1

oral hairy leukoplakia

Answer 1

immunosuppression and EBV

lateral border of tongue

Question 2

lateral tongue, white, doesn’t scrape

Answer 2

oral hairy leukoplakia

**do an HIV test

balloon cells

Question 3

balloon cells

Answer 3

oral hairy leukoplakia

Question 4

black hairy tongue

Answer 4

poor hygiene
-don’t scrape off and debride surface of tongue

tobacco, coffee, tea

Question 5

rash with ampicilin

Answer 5

mononucleosis

Question 6

monospot test

Answer 6

neurophile antibodies - for EBV

-mono test

Question 7

other mono test

Answer 7

mix serum from patient with sheep/horse RBCs

• EBV - creates heterophile antibodies
• positive - agglutination of RBCs - clumping

Question 8

mononucleosis

Answer 8

hyperemic mucosa - posterior pharynx

Question 9

irritation fibroma

Answer 9

bite line - tongue or mucosa
-repetitive trauma

reactive fibroblast tissue

tx - surgical excision

Question 10

pyogenic granuloma

Answer 10

gingiva, tongue
-pregnancy tumor

reactive granulation tissue

• benign inflammatory vascular lesion
• may bleed

common in young people

tx - surgical excision

Question 11

pregnancy tumor

Answer 11

pyogenic granuloma

granulation tissue

Question 12

cancer of oral cavity

Answer 12

95% SCC
5% adenocarcinoma of salivary glands

tobacco and alcohol

india - chew betel quid and paan

oral pharynx - type 16 HPV

Question 13

posterior pharynx cancer

Answer 13

HPV - 16 and 18

Question 14

anterior mouth cancer

Answer 14

tobacco

Question 15

cells pass BM

Answer 15

metastasis

need biopsy to determine lesion is malignant

Question 16

leukoplakia

Answer 16

white patch/plaque
-cannot be scraped off

due to increased keratin

Question 17

hyperkeratosis

Answer 17

not premalignant change

bx needed

Question 18

erythroplakia

Answer 18

red patch

• less common than leukoplakia but more ominous
• 90% dysplasia or CIS

highly vascular eroded mucosa

Question 19

keratin peral

Answer 19

squamous cell carcinoma

Question 20

oral SCC

Answer 20

80% are stage II/III with high rate of recurrence

Question 21

stage 3 and 4 SCC

Answer 21

always radiation

Question 22

CIS SCC of oral cavity

Answer 22

treated like stage 1 - primary surgery/ radiation

Question 23

five hear survival stage 1/2 SCC

Answer 23

70-90%
-need careful follow up

increased risk of second head and neck cancer as well as lung ca

Question 24

wide local excision

Answer 24

oral cavity cancers

Question 25

transoral laser resection

Answer 25

oropharynx, hypopharynx, larynx

Question 26

strawberry tongue

Answer 26

scarlet fever

Question 27

koplik spots

Answer 27

measles

Question 28

acute pharyngitis and tonsillitis - gray white exudative membrane

Answer 28

infectious mono

Question 29

wartons duct

Answer 29

submandibular gland | -gleeking

Question 30

salivary glands

Answer 30

parotid - serous submandibular - mixed sublingual - mixed

Question 31

minor salivary glands

Answer 31

lubrication | -buccal, gingival, palatal mucosa

Question 32

acute b/l tender swelling of parotid and salivary glands lasting 2 days

Answer 32

mumps | -virus

Question 33

mumps complication

Answer 33

testicular inflammation - orchitis sterility may occur

Question 34

parotitis

Answer 34

swelling of parotid gland -mumps may last up to 10 days

Question 35

mumps vaccine

Answer 35

MMR third dose - in outbreak setting contraindication - pregnant, immunosuppressed, malignancy

Question 36

sjogrens syndrome

Answer 36

third most common autoimmune -female age 40yo autoAbs agasinst Ags in salivary glands and lacrimal glands

Question 37

keratoconjunctivitis and xerostomia

Answer 37

sjogrens dry eyes and dry mouth

Question 38

sicca syndrome

Answer 38

dry eyes and mouth | -sjogrens

Question 39

severe sjogrens

Answer 39

risk of NHL

Question 40

diagnosis of xerostomia

Answer 40

bx of salivary gland | -see lymphocytes attacking glands

Question 41

sjogrens association

Answer 41

rheumatoid arthritis | SLE, polymyositis, scleroderma, vasculitis, thyroiditis

Question 42

blurry vision, itchy, dysphagia, dry mouth, inabilty to taste

Answer 42

sjogrens

Question 43

SS-A titers

Answer 43

extraglandular sjogrens disease - synovitis, pulmonary fibrosis, peripheral neuropathy more likely to have early disease onset and longer duration as well

Question 44

mikulicz syndrome

Answer 44

lacrimal and salivary gland enlargement from any cause

Question 45

sjogrens dx

Answer 45

- biopsy - CD4 T cells ans B cells - rheumatoid factor - IgG - ANAs on immunofluorescence - SS-A and SS-B

Question 46

mucocele

Answer 46

msot common lesion of salivary gland - mucous retention cyst block of salivary gland tract often lower lip** tx - excision - if incomplete - recurrence occurs

Question 47

sialolith

Answer 47

blockage of salivary duct - food particle = nidus enlargement with aggregation of dehydrated mucous often submandibular gland

Question 48

bacterial sialadenitis

Answer 48

unilateral duct obstruction causes stasis allows infection - staph aureus or strep viridans acute inflammation - to chronic inflammation

Question 49

benign tumors of salivary gland

Answer 49

pleomorphic adenima - mixed warthin tumor

Question 50

malignant tumor of salivary gland

Answer 50

mucoepidermoid carcinoma adenoid cystic carcinoma

Question 51

pleomorphic adenoma

Answer 51

mixed tumor- benign -of salivary gland 50% of all tumors of salivary gland epithelial and mesenchymal cells -arise from basal myoepithelial cells

Question 52

epihelial and myxoid tumor

Answer 52

pleomorphic adenoma of salivary gland can be left in place 15 years - 10% develop to malignant

Question 53

painless slow growing mobile discrete mass in submandibular/buccal area

Answer 53

pleomorphic adenoma

Question 54

warthin tumor

Answer 54

papillary cystadenoma lymphomatosum 10% salivary tumors, benign -males, 50-60yo, smokers** parotid gland -

Question 55

warthin tumor bx

Answer 55

double layer of eosinophilic epithelial cells over lymphoid stroma*

Question 56

malignant tumors of head and neck

Answer 56

adenocarcinoma mucoepidermoid carcinoma adenoid cystic carcinoma

Question 57

mucoepidermoid carcinoma

Answer 57

parotid - malignant - slow growing grade important for px - high grade - invasive - low-hrade - rare mets mucicarmine stain - for mucin and pink sqamous epidermoid cells

Question 58

adenoid cystic carcinoma

Answer 58

malignant of salivary gland infiltrate along nerve** -perineural invasion recurrent common swiss cheese appearance - holes