Oral lesions

Question 1

What are the risk factors for leukoplakia?

Answer 1

tobacco and ETOH use.

Tobacco is responsible for 70-90%, ETOH increases risk 1.5 fold

Question 2

Leukoplakia can lead to which type of cancer?

Answer 2

sqamous cell carcinoma

Question 3

Adherent white patches and plaques on oral mucosa or tongue is called…

Answer 3

leukoplakia

Question 4

How would you diagnose leukoplakia in a patient whom you suspect has it?

Answer 4

biopsy can show benign hyperkeratosis, parakeratosis, atrophy, inflammation hyperplasia without dysplasia.

Question 5

Which is more common: leukoplakia or erythroplakia?

Answer 5

erythroplakia is less common.

Question 6

What percent of erythroplakia developes into cancer?

Answer 6

80%

Question 7

a patient presents with a red, velvety patch on the floor of the mouth. what is your suspected diagnosis?

Answer 7

erythroplakia

Question 8

What is the distinguishing feature of oral hairy leukoplakia?

Answer 8

vertically corrugated adherent white lesions.

typically on lateral surface of the tongue

Question 9

what is the tx of choice for oral hairy leukoplakia?

Answer 9

none usually indicated

Question 10

A patient presents with ulcers or masses that do not appear to heal. Her dentures have started fitting poorly. Pt. complains of odynophagia, sore throat and weight loss. What is the presumptive diagnosis?

Answer 10

Oral SCC.

Question 11

How does oral SCC present?

Answer 11

1. persistent papules, plaques, ulcers and erosions.
2. changes to dentition, lesions on tongue or lip.
3. dysphagia, odynophagia, sore throat, hoarseness, bleeding, weight loss

Question 12

What do you find on biopsy of oral SCC?

Answer 12

dysplasia defined by presence of mitoses and prominent nuclei.

Question 13

How do you treat oral SCC?

Answer 13

1. ENT referral.

2. surgical resection or radiation/chemoradiation

Question 14

What should be included in the DDx of every pigmented oral lesion?

Answer 14

oral melanoma

Question 15

who typically develops oral melanoma?

Answer 15

patients in 5th-7th decade

Question 16

How do you evaluate suspected oral melanoma?

Answer 16

1. endoscope for paranasal disease
2. CT/MRI of primary site
3. CT or PET to asses lymph node involvement or distant mets

Question 17

Pinkish/blue soft papule filled with gelatinous fluid.

Answer 17

mucocele

Question 18

which herpes virus causes herpetic gingivostomatitis?

Answer 18

HSV-1

Question 19

describe the oral lesions associated with HSV-1

Answer 19

grouped vesicles on an erythematous base

Question 20

HSV-1 can be seen in these locations in the oral cavity…

Answer 20

buccal mucosa, tongue, gingiva, hard palate, pharynx, lips, perioral skin.

Question 21

Describe the prodrome of HSV-1 infection.

Answer 21

pain, burning, tingling 6-48 . hours before lesion appear.s

may have fatigue and low grade fever

Question 22

How do you diagnose HSV-1 infection?

Answer 22

1. clinical presentation
2. viral culture of active lesion
3. tzanck smear (also seen w/ varicella)

Question 23

Tx of HSV-1

Answer 23

oral antivirals at onset of prodrome: acyclovir, valacyclovir, famciclovir

Supportive care: fluids, miracle mouthwash, analgesics

Question 24

What should you tell a patient who has HSV-1 infection?

Answer 24

1. avoid contact w/ elderly, babies, immunocompromised
2. don’t kiss, share beverages, etc.
3. have good hand hygeine
4. avoid salty, acidic, sharp foods
5. educate on prevalence to reduce stigma

Question 25

Differentiation of HSV from herpes zoster?

Answer 25

h. zoster occurs unilaterally on the hard palate.

Question 26

What areas are spared in coxsackie infection?

Answer 26

gingiva and lips

Question 27

What pathogen is responsible for oropharyngeal candidiasis?

Answer 27

candida albicans

Question 28

what risk factors are associated with oropharyngeal candidiasis

Answer 28

1. infancy 2. denture wear 3. immunocompromised 4. DM 5. chemo/radiation 6. broad spectrum abx 7. CS

Question 29

How would you describe the presentation of oropharyngeal candidiasis?

Answer 29

1. presents with ST, mouth pain. 2. creamy white patches/plaques w/ underlying erethematous mucosa. 3. "thrush will brush" 4. angular cheilitis

Question 30

Diagnosis of oropharyngeal candidiasis

Answer 30

KOH prep.

Question 31

Tx for oropharyngeal candidiasis?

Answer 31

1st line: topical nystatin, oral suspension 2nd line: clotramazole oropharengeal lozanges Pt. education to clean carefully.

Question 32

What induces erythema multiforme major?

Answer 32

1. HSV

Question 33

EMM presents with...

Answer 33

1. target lesions on skin | 2. duffuse mucosal erythema, painful erosions or bullae

Question 34

Where can lesions of EMM be found?

Answer 34

oral mucosa, genitals

Question 35

Tx for EMM?

Answer 35

symptomatic tx including: 1. topical CS for cutaneous lesions 2. oral antihistamines 3. miracle mouthwash

Question 36

Precaution for EMM?

Answer 36

ocular involvement, emergent ophthalmology referral

Question 37

A patient presents with a several shallow, oval shaped lesions with a grayish base on the buccal and labialmucosa. What is the presumptive diagnosis?

Answer 37

1. aphthous ulcer.

Question 38

Tx of apthous ulcer?

Answer 38

1. self-limiting (10-14 days) 2. avoid irritating food/drink 3. topical CS if needed (oralone)

Question 39

How would you describe the presentation of behcet syndrome?

Answer 39

1. recurrent oral and genital ulcers mostly involving the scrotum and vulva. 2. painful, shallow to deep, with central yellow necrotic base

Question 40

Dx of behcet syndrome

Answer 40

``` 1. 3 or more ulcers/year and either: recurrent genital ulcers occular lesions cutaneous lesions posive pethergy test ```

Question 41

Tx for behcet syndrome?

Answer 41

rheumatology referral

Question 42

Describe the process of the pathergy test...

Answer 42

1. tests for nonspecific hyperreactivity of the skin following minor trauma 2. intradermal injection w/ sterile 20 gauge needle 3. positive if erythematous sterile papule develops within 48 hours

Question 43

Three componants to oral lichen planus presentation:

Answer 43

1. reticular, lacy white plaques on buccal mucosa 2. erythematous 3. erosive

Question 44

Tx for oral lichen planus:

Answer 44

1. pain relief | 2. high potency CS

Question 45

precaution for topical CS use in oral cavity:

Answer 45

1. dry with gauze first, avoid eating and drinking for 30 minutes.

Question 46

What is associated with black hairy tongue?

Answer 46

1. abx 2. candida infection 3. poor hygeine

Question 47

Tx of black hairy tongue

Answer 47

brush affected area w/ soft bristles and toothpaste BID/TID

Question 48

Presentation of geographic tongue:

Answer 48

erythematous patches on dorsal tongue w/ circumferential white borders. may change location, pattern and size

Question 49

Etiology of atrophic glossitits?

Answer 49

inflammatory disorder leading to atrophy of filiform papillae

Question 50

A pt. presents with a smooth, glossy, erythematous tongue and reports burning sensation when eating acidic or salty foods. What is the presumptive diagnosis?

Answer 50

atrophic glossitis

Question 51

What preparations do you prescribe for few localized lesions?

Answer 51

gels

Question 52

what preparation do you prescribe for generalized erythema?

Answer 52

rinse

Question 53

What should you always educate patients about when prescribing topical CS?

Answer 53

oral candidiasis

Question 54

When there are severe lesions and symptoms, what do you prescribe?

Answer 54

systemic therapies.