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Clinical Medicine > Oral lesions > Flashcards

Oral lesions Flashcards

1
Q

where can candida albicans be cx’ed

A

mouth, vagina, feces

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2
Q

treatment of geographic tongue

A

reassurance

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3
Q

diagnosis for aphthous ulcers

A

clinical

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4
Q

non specific entities describe mucosal plaques as red or speckeled

A

erythroplakia, leukoplakia

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5
Q

____% of population are candida albicans carriers

A

20-30%

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6
Q

diagnosis of behcet syndrome

A

clinical (>3 x per year recurrence for oral ulcers) AND 2 other clinical findings (recurrent genital ulcers, ocular lesions, and or cutaneous lesions, pos pathergy test)

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7
Q

diagnosis of oropharyngeal candidasis

A

clinical confirmed by KOH prep: budding yeasts with or without pseudohyphae

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8
Q

coxsackie A16 virus

A

HFM

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9
Q

adherent white patches/ plaques on oral mucosa/ tongue, not painful, erythroplakia, leukoplakia

A

leukoplakia

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10
Q

treatment for severe EMM oral mucosal involvement

A

systemic glucocorticoids if can’t tolerate PO may need to be hospitalized

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11
Q

treatment for EMM mild/ moderate

A

1- self limited 2- symptomatic relief (top corticosteroids, oral antihistamines, miracle mouthwash)

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12
Q

oral lichen planus treatment

A
  • pain relief - high potency topical corticosteroids (triamcinolone oropharyngeal (oralone) or clobestasol)
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13
Q

fever, malaise, sore throat prodrome

A

coxsackie

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14
Q

oral lichen planus diagnosis

A

biopsy/ ENT referral

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15
Q

denture wearers have painful red palate (atrophic form)

A

thrush

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16
Q

prodome of mucose membrane pemphigoid lasts

A

weeks to months

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17
Q

ways to evaluate melanoma

A
  • endoscopic- paranasal disease - CT and/or MRI of primary site - Ct and/or PT lymph to assess metastasis
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18
Q

glossitis

A

inflammation of the tongue

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19
Q
  • ulcers or masses that don’t heal - persistent papules, plaques, ulcers, erosions - dental changes or poorly fitting dentures - painful exophytic/ ulcerative lesions on tongue orlip - dysphagia, odynophagia, sore throat, hoarseness
A

SCC

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20
Q

fluid filled cavities with mucous glands lining the epithelium

A

mucoceles

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21
Q
  • maybe asymptomatic - symptomatic- sudden onset, painful intraoral grouped vesicles on an erythematous base usually on buccal mucosa - high fever, lymphadenopathy, decreased oral intake
A

primary infxn of HSV

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22
Q

exanthem

A

skin eruption

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23
Q

<10% TBSA

A

SJS

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24
Q

amount of mucosal involvement with SJS

A

90%

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25
Q

___ of leukoplakia lesions will progress to carcinoma within 10 years

A

1-20%

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26
Q

what kind of infection is oropharyngeal candidiasis

A

opportunistic infection- when conditions are right for growth

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27
Q

mouth pain/ sore throat, beefy red tongue, difficulty eating, creamy white patches/ plaques with underlying erythematous mucosa on buccal mucosa, palate, tongue, or oropharynx (pseudomembranous form)

A

oropharyngeal candidasis

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28
Q

pale oval shaped puapules with a rim of erythema on the palmar/ plantar surfaces

A

coxsackie

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29
Q

most common clinical manifestation of primary HSV in childhood

A

herpetic gingivostomatitis

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30
Q

variable in size, pinkish/ blue soft papules or nodules filled with gelatinous fluid, may be seen in labia, may spontaneously rupture

A

mucoceles

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31
Q

mucoceles diagnosis

A

clinical

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32
Q

often on older pts 50-70

A

melanoma

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33
Q

SNE labs

A

ANA- double stranded DNA, anti-smith antibody

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34
Q

supportive care treatments of HSV

A

fluids, analgesics, “miracle mouthwash”, diphenhydramine (benadryl), aluminum hydroxide/ magnesium carbonate (Maalox or gaviscon)

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35
Q

neutrophilic inflammatory lesions

A

behcet syndrome

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36
Q

diagnosis for EMM

A

clinical and Bx

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37
Q

diagnosis of leukoplakia is by

A

biopsy

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38
Q
  • lacy white plaques (wickham’s striae) on buccal mucosa sometimes with large, painful, hyperkeratotic plaques - painful red patches (muscular atrophy) - painful erosions/ ulcers
A

oral lichen planus

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39
Q

fever, fatigue, myalgia, unintentional weigh loss, painless oral &/ or nasal ulcers

A

SLE

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40
Q

benign migratory glossitis

A

geographic tongue

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41
Q

when is viral shedding the highest with HSV-1

A

the primary infection lessens with recurrences

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42
Q

tongue appears smoothy, glossy, erythematous with burning sensation and increased sensitivity to acidic/ salty foods

A

atrophic glossitis

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43
Q

acute immune mediated condition that has genetically susceptibility

A

EMM- Erythema Multiforme Major

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44
Q

autoimmune disease that w/ oral ulcers malar rash, photosensitivity, and discoid lupus that also affects many organs and has mild to severe remissions/ relapses

A

SLE- systemic lupus erythematosus

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45
Q

recurrent oral or genital ulcers (75% scrotum , vulva) that are painful, shallow, or deep with central yellowish necrotic base, extensive and often multiple

A

behcet syndrome

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46
Q

treatment for atrophic glossitis

A

address underlying condition

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47
Q

w/ coxsackie, throat lesions resolve in

A

5-6 days

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48
Q

>30% TBSA

A

TEN

49
Q

HSV treatment

A
  • antiviral at onset of prodrome - supportive care
50
Q

when do aphthous ulcers occur and why

A

20’s, idopathic

51
Q

painful lesions usually on cutaneous surface or keratinized areas (lip)

A

active phase of HSV-1 recurrent infxn “cold sores”

52
Q

affects eptihelium of tongue

A

benign migratory glossitis

53
Q

behcet syndrome treatment

A

refer to rheumatology

54
Q

single/ multiple oral lesions: shallow, round/ oval, painful with grayish base, yellow- gray centers with red halos on buccal/ labial mucosa

A

aphthous ulcers

55
Q

infancy, dentures, immunocompromised, DM, chemo/ radiation, abx (broad spectrum), corticosteroids (topical & systemic)

A

predisposing factors for oropharyngeal candidasis

56
Q

there is a possibility of ____ with topical immunosuppressants

A

oral candidas

57
Q
  • elongated filiform plpillae - pseudohairy tongue (yellow/ white/ brown dorsal tongue surface)
A

lingua villosa nigra

58
Q

treatment for oropharyngeal candidiasis

A

disinfect/ replace toothbrushes, pacifiers topical antifungal pt education

59
Q

SCC diagnosis

A

biopsy

60
Q

treatment for ocular involvement of EMM

A

refer to opthamologist

61
Q

severe or many oral lesions can be treated by

A

systemic therapy

62
Q

painful oral lesions- small aphthae that spare gingiva and lips

A

coxsackie

63
Q
  • ENT referral - surgical resection/ radiation/ chemoradiation- dependent on stage/ extent of disease
A

SCC treatment

64
Q

inflammatory disorder that leads to atrophy of the filiform papillae

A

atrophic glossitis

65
Q

mucoceles treatment

A

avoid cheek/ lip biting, if symptomatic remove (cryo/ excision), CO2 laser vaporization, aspiration

66
Q

etiology of EMM

A

-infection (HSV most common) - <10% assoc with meds (NSADIS, sulfa, antiepiletics, abx)

67
Q

usually asymptomatic, occasional oral discomfort, burning, or foreign body sensations with numerous exacerbations/ remissions over time

A

geographic tongue

68
Q

coxsackie diagnosis

A

clinical

69
Q

severe life threatening mucotaneous rxn

A

SJS

70
Q

treatment for lingua villosa nigra

A

brush area of tongue BID-TID w/ toothbrush and toothpaste

71
Q

treatment for pemphigus

A

systemic corticosteroids and immunosuppressants, viscous lidocaine (topical for oral lesions), triamcinolone acetonide (dental paste), abx (for secondary infxn), maybe hospitalization often chronic course of treatment

72
Q

odynophagia

A

symptoms of gastroesophageal reflux

73
Q

erythema and edema of lips, intraoral bullae, ruptured bullae, painful friable raw surfaces with hemorrhagic crusts

A

SJS

74
Q

diagnosis of geographic tongue

A

clinical or bx

75
Q

caused by nutritional deficiencies, malnutrition, dry mouth, sjogrens syndrome, oral candida infxn, celiac

A

atrophic glossitis

76
Q

topical steroid for aphthous ulcers

A

triamcinolone oropharyngeal paste (oralone)

77
Q

ulcerative stomatitis apthae, “canker sores”

A

apthous ulcers

78
Q

nonspecific hyperreactivity of the skin after minor trauma intradermal injection into skin with 20 gauge needle, pos if erythematous papule develops w/in 48 hours

A

pathergy test

79
Q

female, long duration of leukoplakia, nonsmoker, location on the tongue or floor of mouth, and being >200 mm are risk factors for

A

risk factors for precancerous leukolpakia SCC’s becoming malignant

80
Q

tobacco, alcohol, UV exposure, radiation, HPV-16 risk factors for

A

risk factors SCC

81
Q

chronic inflammatory disorder affecting skin and mucous membranes that may increase risk of oral cancer

A

oral lichen planus

82
Q

etiology of mucoceles

A

mild/ minor oral trauma

83
Q

acantholysis

A

skin sloughing

84
Q

topical antifungal for thrush

A

nystatin clotrimazole lozenges (troches)

85
Q

angular cheilitis or preleche

A

painful fissuring at the corners of the mouth, assoc with thrush

86
Q

HSV antivirals

A

acyclovir, valacyclovir, famciclovir (treat primary infection longer)

87
Q

lesions occur over 3-5 days and resolve in about 2 weeks

A

EMM

88
Q

most common cause of mouth ulcers

A

recurrent aphthous stomatitis

89
Q

HSV education

A
  • active lesions –> avoid immunocompromised - oral transmission spreads - proper hand hygiene - avoid salty/ acidic/ sharp foods - sunscreen - virus will be there indefinitely with recurrence freq varying - high prevalence
90
Q

treatment for aphthous ulcers

A

heal w/in 10-14 days, avoid irritating drinks/ foods, symptomatic relief (topical steroid)

91
Q

tobacco (esp chewing), alcohol, and HPV are risk factors for

A

risk factors for leukoplakia

92
Q

exophytic

A

lesion that grows out from epithelial surface

93
Q
  • avoid tobacco, alcohol, cheek biting, tongue chewing - regular dental care - refer to ENT for eval/ oral surgery - monitor closely for enlargement or induration
A

treatment for leukoplakia

94
Q

candida albicans

A

oropharyngeal candidas aka thrush

95
Q

pemphigus requires ____ evaluation

A

urgent dermatology

96
Q

diagnosis of pemphigus

A

lesional and perilesional bx

97
Q

treatment for melanoma

A
  • excision with clear margins - radiation therapy
98
Q

mucous membrane pemphigoid treatment

A

topical and/or corticosteroids + dermatology referral

99
Q

odynophagia

A

pain with swallowing

100
Q

treatment for SJS/TEN

A

stop meds, admit (maybe burn unit/ICU), supportive care

101
Q

if oral lesion is pigmented you must

A

consider melanoma in the DDx

102
Q

prodrome of recurrent HSV-1 infxn

A
  • pain/ burning/ tingling 6-48 hours before lesions appear, - fatigue - low grade fever
103
Q

precipitating factors of HSV-1

A

sunlight, fever, trauma, stress, menses

104
Q

stomatitis

A

inflammation of the mucous membranes of the mouth

105
Q

few localized oral lesions can be treated with

A

topical steroid gel- dry the area before applying and avoid eating/ drinking for 30 minutes after

106
Q

diagnosis of HSV

A
  • clinical - viral culture of active lesion - tzanck smear (look for multinucleated giant cells) - serology (look for HSV-1 antibodies)- not reliable
107
Q
  • often discovered during routine dental visits - painless bleeding mass - area of ulceration - region of mucosal discoloration - ill-fitting dentures
A

melanoma

108
Q

target like lesions accompanied by diffuse areas of mucosal erythema, painful erosions, or bullae

A

EMM

109
Q

leukoplakia associated with erythematous appearance

A

higher risk of dysplasia or cancer (90%)

110
Q

frequent hand washing to prevent spread maintain hydration (popsicles) analgesics (acetaminophen/ ibuprofen)

A

treatment for coxsackie

111
Q

painful erosion lesions with ruptured bullae

A

pemphigus

112
Q

70% effects oral mucosa, as well as genitals and or ocular mucosa

A

EMM

113
Q

enanthem

A

mucous membrane eruption

114
Q

benign condition associated with abx use, candida albicans infxn, poor oral hygiene

A

black hairy tongue (lingua villosa nigra)

115
Q

family hx, trauma, stress, hormones, infxn, immunocompromised, celiac/ IBD, vitamin/ mineral deficiencies

A

risk factors for aphthous ulcers

116
Q

pt education for thrush

A

clean dentures carefully and frequently, rinse mouth after use of steroid inhalers

117
Q

erythematous patches on dorsal tongue w. circumferential white borders that can change location, pattern, and size in minutes

A

geographic tongue

118
Q

EMM gene

A

HLA

119
Q

esophageal candidiasis, recurrent candidiasis, or lack of predisposing factors warrant

A

further investigation for underlying disease (HIV, DM)

Clinical Medicine (5 decks)

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