Oral Surgery III - The Whole Enchilada Flashcards Preview

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Flashcards in Oral Surgery III - The Whole Enchilada Deck (78):
1

Fluid in or under the epithelium; a large blister

Bulla

2

Dried or clotted serum protein on surface of skin or mucosa

Crust

3

a superficial ulcer or excoriation

Erosion

4

A circumscribed area of color change without elevation

Macule

5

A large palpable mass, elevated above the epithelial surface

Nodule

6

A small palpable mass, elevated above the epithelial surface

Papule

7

A flat but elevated lesion

Plaque

8

A cloudy or white vesicle filled with pus

Pustule

9

A macroscopic accumulation of keratin

Scale

10

A loss of epithelium

Ulcer

11

A small loculation of fluid in or under the epithelium; a small blister

Vesicle

12

Any lesion that persists for _____ weeks with no apparent etiologic basis is a _________

2 weeks

Indication for biopsy

13

Any inflammatory lesion that does not respond to local Tx with _____ days is basis for a Biopsy

10-14 days

14

Persistent ______ changes in superficial tissue is an indication for Biopsy

hyperkeratotic

15

Any persistent _________ is an indication for Biopsy

tumescence (swelling)

16

________ Inflammatory changes of _______ is an indication for Biopsy

Persistent

unknown cause

17

Lesions that interfere with _________ is an indication for Biopsy

local function

18

Any lesion that has characteristics of ________ is an indication for Biopsy

Malignancy

19

7 Indications for Biopsy:

2 week lesion w/out etiologic basis

10-14 day non-responsive inflammatory lesion

Persistent superficial hyperkeratosis

Persistent tumescence

Inflammatory changes of unknown causes that persist

Lesions interfering with Local Function

Looks like Malignancy

20

7 things that may indicate Malignancy:

Erythroplasia (red/speckled red/white)

Ulceration

Duration longer than 2 weeks

Rapid growth

Bleeding

Induration - (loss of pliability)

Fixation - feels attached to adjacent structures

21

4 types of Biopsy:

Cytology

Aspiration

Incisional

Excisional

22

Cytology was first used as a _______

Some studies find high _______

Must be examined by ________

pap smear

false negatives

pathologist

23

What is the prime indication for Cytology biopsy?

Large areas of mucosal change monitored for Dysplasia

24

An Aspiration Biopsy must be done on what prior to surgical intervention?

Any Radiolucency

*could by high flow vascular lesion

25

A Fine Needle Aspiration Biopsy is indicated in the Tx of solitary ______ masses suspected to represent a tumor

___ gauge or smaller needle is used

Parotid

21

26

An Incisional Biopsy samples what part of a lesion?

Representative

27

3 Reasons to do an Incisional Biopsy:

over 1 cm/close proximity to vital anatomic structures

Difficult to excise

Suspicion of Malignancy

28

Shape of an Incisional Biopsy:

Include:

Do what for the pathologist?

Wedge

normal tissue at edges

orient

29

T/F
Incisional Biopsy should by broad and shallow

False

**narrow and deep enough to go all the way through the structure

30

An Excisional Biopsy should be done only in what cases?

Good for what size lesions?

Malignancy NOT expected

1 cm or less

31

Biopsy Technique should use regional _____ and use _____ incisions

field blocks

sharp

32

A Biopsy sample is placed directly into ________

10% Formalin

33

MRONJ =

Medication Related Osteonecrosis of the Jaws

34

T/F
Osteoradionecrosis of the jaws is pretty much the same as MRONJ in treatment and response

False

*NOT the same, in any way

35

MRONJ is defined as _______ bone that can be probed (intra/extra oral fistula) in the MF region persisting for ________

exposed

8 weeks

36

MRONJ does NOT refer to _______, but its causes are what 2 types of drugs?

radiation therapy

antiresorptive, antiangiogenic

37

T/F
MRONJ is a fairly new disease and huge numbers of people are on meds that put people at risk

True

38

T/F
Normal course of debriding bone and moving flaps, successful for other Tx, does not tend to work for MRONJ

True

39

T/F
Hyperbaric Oxygen (HBO) works well for MRONJ

False

*osteoradionecrosis, etc.

40

With MRONJ, wounds tend to ______ with surgical intervention

enlarge

41

T/F
There is no definitive Tx for MRONJ

True

42

T/F
MRONJ pts may have to be on continuous or episodic antibiotics for the rest of their lives

True

43

T/F
Oral bisphosphonates, RANK-L inhibitors, monoclonal antibodies, and anti-angiogenesis drugs can all cause MRONJ

True

44

How many cases of MRONJ have been reported in the literature?

17,000

45

3 types of Antiresorptives associated with MRONJ:

IV bisphosphonates

Oral bisphosphonates

RANK Ligand inhibitor (human monoclonal antibody)

46

What 4 conditions are Treated with MRONJ-causing drugs ?

Cancers that metastasize to bone (breast, prostate, lung)

Bone lesions/multiple myeloma

Osteoporosis

Soft tissue tumors

47

3 Common Oral Bisphosphonates:

*used for Osteoporosis

alendronate Fosamax

risendronate Actonel

ibandronate Boniva

48

2 IV Bisphosphonates

*used for Bone Metastases

pamidronate Aredia

zoledronate Zometa

49

Name of the RANK-L inhibitor

*monoclonal antibody used for Bone Metastases

denosumab Xgeva

50

Name of RANK-L inhibitor

*monoclonal antibody used for Osteoporosis

denosumab Prolia

51

Bisphosphonates and RANK-L both work by inhibiting what?

Osteoclast activity

52

Osteoclasts, though they break bone down, release ______ and growth factors

BMP

53

Antiangiogenic meds interfere with the formation of vessels/vascular supply and cause what?

Avascular Necrosis

54

denosumab (anti RANKL antibody) is doses via _______ injection at an interval of _______

subQ

6 months

55

More than ___ million osteoporotic fractures accor in the US every year

This places ________ people in nursing homes

1.5 million

180,000

56

T/F
Hip fracture mortality exceeds 20%

True

57

The annual direct care expenditure on osteoporotic fracture was ______ in 2002

*expected to double or triple by 2050

12 to 18 Billion dollars

58

What is the systemic marker of bone turnover to assess MRONJ risk?

What are the parameters?

Is it useful in all pts?

CTX - collagen type I C telopeptide

100 - 150 moderate risk (less than high, greater than minimal)

no

59

CTX - collagen type 1C telopeptide is NOT a useful test in what 3 pts?

Cancer

methotrexate (falsely low)

Steroids (falsely low)

60

Is the CTX test a valid systemic test for MRONJ?

No

61

Ideally, before IV BP therapy, you should extract nonrestorable teeth, eliminate perio, and treat caries

During therapy avoid anything invasive

Treat caries, splint, etc

True

62

If surgery is unavoidable with a pt taking IV BP, what is the most important thing?

Informed Consent

63

T/F
Pts should have a dental screening and preventative Tx PRIOR to initiating antiresporptive or antiangiogenic therapy

True

64

To prevent MRONJ, pts should take a drug holiday off of oral BP or denosumab for what disease?

At what time?

Osteoporosis

4 years

65

T/F
If MRONJ develops in a Cancer Pt, the oncologist may consider discontinuing therapy until soft tissue closure

True

66

MRONJ must be addressed in pts taking antiresorptive therapy b/c it is likely to exceed ____ years

4

67

T/F
Implant placement should be avoided in pts on IV bisphosphonates or antiangiogenic drugs for Cancer

***also avoid direct osseous injury

True

True

68

For Osteoporosis pts taking BP, if there are no clinical risk factors, you don't have to alter or delay surgery on what condition?

Pt taking BP LESS than 4 years

69

Osteoporosis pts taking BP less than 4 years taking _____ or _______, must contact prescribing provider for a Drug Holiday for at least ____ before oral surgery and wait for osseous healing

corticosteroids, antiangiogenics

2 months

70

Osteoporosis pts taking BP for MORE than 4 years w/ or w/out concomitant therapy, contact prescribing provider for ________ before oral surgery and wait for osseous healing

drug holiday for 2 Months

71

If Ostoporosis pt taking drug over 4 years, how long of a drug holiday for Prolia (denosumab) prior to surgery?

Reclast (zolendronate)? before/after

3 months

9 months / 3 months

72

What are 3 indications for jaw Resection in MRONJ?

won't respond to nonsurgical Tx

Fractures

Direct sinus

73

alendronate may reduce the risk of hip fx by ___%

***could prevent 100k fxs and thousands deaths

40

74

T/F
90% of MRONJ pts can be maintained pain free

True

75

T/F
MRONJ is rare, less severe, and reversible with discontinuation of IV

False

***only true for ORAL meds

76

T/F
3 of the 4 diognostic criteria for MRONJ are historic data so you have to ask many questions to make a diagnosis

True

77

What is the important time frame for the duration of dosing of Oral BP's?

4 years

78

IV BP's are significantly more likely to cause MRONJ

***often given w/ chemo, so Ask About Hx!!
Zometa, Aredia, Xgeva...

True

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