ORAL PATH II exam 1-RED & WHITE lesions Flashcards
(43 cards)
Prov Clin Dx: A 57 year old female presented complaining of a “painful mouth”. Clinical examination revealed multiple, irregular WHITISH plaques MIXED with areas of ERYTHEMA… it is WIPEABLE
Pseduomembranous Candidiasis
What are the three possible treatments for Candidiasis and what is the method of delivery of each?
1.NYSTATIN (tablets or rinse) 2.CLOT-RIM-AZOLE (tablets) 3.FLU-CON-AZOLE (systemic pill)
Whats the Diff Dx (2) and Provisional Clincial Dx of a 25 y/o white male that presents with a large irregular white plaque in his R buccal mucosa that is BOTH wipeable AND non-wipeable..
1.Frictional Keratosis 2.Chemical/Physical Burn…Prov Clin Dx: Chemical/Physical Burn
Diff Dx: A 62 year old white female presented with a 1 cm white plaque on the left lateral border of her tongue.
1.Frictional Keratosis 2.Leukoplakia 3.Lichen Planus (Determined to be Leukoplakia)
Diff Dx (4): A 27 year old male had asymptomatic WHITEISH PAPULES of his buccal mucosae. He was unaware of their presence.
1.Focal Epithelial Hyperplasia (Heck’s Disease) **2.Papular Lichen Planus (prov clin dx) 3.Candidosis 4.Morsicatio Buccarum
What are the 4 (maybe 5?!?!lol) variants of Lichen Planus?
1.Erosing Form 2.Bullous Form 3.Pigmented Form 4.Striated/Retucilar (5. Papillary?!)
What is the most common form of Lichen Planus?
Reticular
Say Whaaat??! Please give me the provisional clincial dx for this crazy one…A 29 year old white male came with buccal mucosae were covered with EXTENSIVE WHITE PALQUES. He stated the condition was ASYMPTOMATIC and had been present AS LONG AS HE COULD REMEMBER. (What is the GROUP of lesions called? What is the SPECIFIC Dx?)
GENO-KERATOSIS-the name for a GROUP of lesions that cause white lesions caused by genetics (wide spread, asymptomatic)..the ONE that a Dentist should remember is WHITE SPONGE NEVUS (Autosomal Dom)
Say a 59 y/o white male comes into the office with a WHITE lesion about 1cm on the FLOOR of the mouth…What are the 2 possibilities if it is wipeable?
1.Candidiasis 2.Burn
Say a 59 y/o white male comes into the office with a WHITE lesion about 1cm on the FLOOR of the mouth…What are the 4 possibilities if it is NON-wipeable?
1.Hypertrophic Candidiasis 2.Frictional Keratosis 3.Lichen Planus 4.Leukoplakia (which can then be diagnosed histologically as Hyperkeratosis, Carcinoma in situ, Squamous cell carcinoma, or epithelial dysplasia
Say a 59 y/o white male comes into the office with a WHITE lesion about 1cm on the FLOOR of the mouth and its NON-wipeable…whats your Provisional Clinical Dx?
Leukoplakia
WHAT DO 80% OF LEUKOPLAKIA’S REPRESENT HISTOLOGICALLY??? What about the other 20%?
80%-HYPERKERATOSIS…20%-Epithelial Dysplasia
Why are areas like the ventral and lateral tongue, the floor of the mouth, and the lower lip more susceptible to epithelial dysplasia during leukoplakia than other sites? (3 reasons)
- Gravity keeps carcinogens (EtOH, tobacco) in the area 2.Thin epithelium in those areas (carcinogen closer to basal cells undergoing change) 3.Non-keratinized tissue
What is the treatment protocol for finding a hyperkeratotic leukoplakia?
- Biopsy once every 3-4years. 2. Monitor/Recall 4x/year
Diff Dx (3): A 68 year old white female, with a 1 x 3 cm white plaque on the left posterior lateral border of her tongue. Painful and occasionally BURNED, especially when eating spicy foods.
1.Frictional Keratosis 2.Hypertrophic Candidiasis 3.Leukoplakia (the prov clin dx here)
Why is a NON-homogeneous leukoplakia more troubling than a homogenious lesion?
50-80% of non-homogenous leukoplakias are dysplastic
Diff Dx (2) and Prov Clin Dx: A 66 year old male complains of the unsightly appearance of his lower lip. The lesion does not rub off.
1.Leukoplakia 2.AC-TIN-IC KERATOSIS…Actinic Keratosis is provisional clinical diagnosis
Diff Dx (3): A 72 year old white male presented to your office for the fabrication of new dentures. During your soft tissue exam you find a small 1cm WHITE plaque on the left posterior LATERAL BORDER of his tongue at the junction with the FLOOR OF THE MOUTH.
1.Leukoplakia 2.Candidiasis 3.SQUAMOUS CELL CARCINOMA
PROVISIONAL CLINICAL DX: A 31 year old white male, multiple areas of mild erosion on the DORSAL and LATERAL borders of his tongue. Many of the areas are bordered by distinct WHITE LINES. The patient is ASYMPTOMATIC and unaware of the condition.
Erythemia Migrans (Geographic Tongue)
Diff Dx (3): This 46 year old white female had a PAINFUL and BURNING mouth. Multiple RED, eroded areas BILATERALLY on her BUCCAL mucosa.
1.Erosive Lichen Planus 2.Mucus Membrane pemphagOID 3. Allergic Reaction
What is the key determinant in a POSITIVE Nikolsky sign? What is a prime example of a pathology with a positive Nikolsky sign?
Sloughing. If there is sloughing, it is a POSITIVE Nikolsky sign and is therefore PemphagOID
What is the key determinant in a NEGATIVE Nikolsky sign and what are two examples that will show this result?
NO sloughing of the tissue…1. Lupus 2.Lichen Planus
If our microscopic/histologic analysis comes back from this pt: This 46 year old white female had a PAINFUL and BURNING mouth. Multiple RED, eroded areas BILATERALLY on her BUCCAL mucosa….and there were WHITE STRIAE, what does that indicate?
Erosive Lichen Planus
What is the name and type of medication we can use OFF LABEL for treating the painful side effects of Erosive Lichen Planus?
Topical Cortico-Steroids: FLU-O-CIN-O-NIDE gel (Lidex)