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CMS2 > Oral Ulceration > Flashcards

Oral Ulceration Flashcards

1
Q

What is an ulcer?

A

A full thickness breach of the epithelium”

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2
Q

What sorts of questions should you ask when taking a history for oral ulceration?

A
  1. Number?
  2. Size?
  3. Site/ Where?
  4. Frequency?
  5. Duration?
  6. Ulcer free period?
  7. Pain?
  8. Habits?
  9. Associations? - food/menstrual period?
  10. Family history?
  11. Systemic - GI, weight loss, blood in stools, abdominal pain
  12. MH?
  13. Medication/dose change?
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3
Q

Which form of RAS commonly results in scarring?

A

Major RAS

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4
Q

What medication can cause oral, ocular ulceration?

A

Nicorandil

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5
Q

Why is it important to decide if the ulcer is persistent or recurrent?

A

Oral cancer can present as a single persistant oral ulcer

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6
Q

if you suspect oral cancer what must you do?

A

refer that SAME day under local referral pathway

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7
Q

what must you include in the referral for suspicious oral cancer lesions?

A
  • clinical photos
  • medical/social history
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8
Q

what type of investigations might be needed in ROU?

A

FBC, haematinics and coeliac screening bloods

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9
Q

what is ROU?

A

recurrent oral ulceration (refers to ANY cause for recurrent oral ulcers)

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10
Q

What is RAS?

A

Recurrent aphthous stomatitis? (specific diagnosis)

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11
Q

What are the 3 variants of RAS?

A

minor, major and herpetiform?

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12
Q

is there a strong genetic predispostion with RAS?

A

Yes!

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13
Q

What is the rough amt of ulcers you would see in minor, major and herpetiforme RAS

A

1-5
1-10
10-100

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14
Q

what would you expect the size of the ulcers to be in minor, major and herpetiforme RAS?

A

<10mm
>10mm
1-2mm

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15
Q

what would the duration of each ulcer be in minor, major and herpetiforme RAS?

A

4-14
>30
<30

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16
Q

what type of RAS commonly leads to scarring?

A

Major RAS

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17
Q

What is the most common form of RAS?

A

minor RAS

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18
Q

What are some causes of persistent oral ulceration?

A

SCC (squamous cell carcinoma)
trauma
medication-related

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19
Q

What are some conditions that lead to (ROU) recurrent oral ulceration?

A

IBD
Coeliac
Behcet’s
Cyclical neutropenia

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20
Q

What information might a FBC give?

A

presence of anemia or if pt is suffering a clinical infection or potential hematological causes

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21
Q

what information might haematinics give?

A

Deficiency in B12, folate, ferritin

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22
Q

What information might serum ACE, ESR and CRP give?

A

generic markers of generalised inflammation - helpful in diagnosis/management of IBD

23
Q

When would you use the term RAS?

A

When there is no underlying pathological process or diagnosis causing the ulcers

24
Q

What are subtle clinical signs of parafunctional habits?

A

pronounced buccal ridging
linea albae
scalloped edges to the tongue
concomitant TMD secondary to clenching or grinding
NCTSL

25
Q

What would be suitable management for parafunctional ulcers?

A

Education
Pain relief (topical agents - Gelclair)
2-3mm soft bite guard

26
Q

What management approach should be taken for patient with oral ulceration?

A
  1. IDENTIFY CAUSE! - early decision making regarding ulcer is a presentation of oral cancer
  2. Provide pt with leaflets and information
  3. simple strategies to alleviate pain and functional problems from ulcers
  4. Take photos!
27
Q

What are the reasons to refer to Oral Medicine for oral ulceration?

A

Doubt over diagnosis
partial/non-response to topical treatments
severe presentation (rapid onset), extensive mucosal surfaces ulcerated or multiple systems involved (skin, gut, eyes)
Major RAS
Known or suspected medication condition/medication contributing to ulcer

28
Q

Where do herpetiforme ulcers tend to appear?

A

ventral tongue, floor of mouth and lower labial mucosa

29
Q

what antibiotic can be prescribed and is supposedly good for herpetiforme RAS?

A

Doxycycline

30
Q

What is Behcet disease?

A

rare disease causes vasculitic changes in multiple body tissue

31
Q

what are other potential effects of behcet disease (apart from aphthous ulceration)

A

ocular changes, headaches, genital ulceration, acne form lesions, myalgia, arthralgia

32
Q

Who is commonly affected by Behcet disease?

A

male patients
aged 20-30 most commonly

33
Q

what is neutropenia? how might it be acquired?

A

depletion of white blood cell - neutrophil
acquired following chemotherapy or secondary to significant infections

34
Q

what is cyclic neutropenia?

A

inherited disorder - neutrophil count falls every 21 days

35
Q

what is the clinical presentation of oral lichen planus?

A

oral ulceration + patchy erythema = white patches

36
Q

what does primary herpetic gingiva stomatitis present as in the mouth? what site does it normally affect?

A

little tiny ulcers on the ventral surface of tongue

37
Q

what are the supportive measures of primary herpetic gingiva stomatitis?

A
  • well hydrated, paracetamol, keeping everything clean, chlorhexidine mouthrinse
38
Q

if the ulcers feel firm as opposed to soft what would we be advised to do?

A

undertake an urgent biopsy (usually within 2 weeks) to confirm diagnosis

39
Q

what is bullous pemphigoid?

A

rare skin condition

40
Q

what is mucous membrane pemphigoid?

A

rare, chronic, autoimmune disorder that typically affects the mucous membranes more often than the skin

41
Q

what area of the mouth does mucous membrane pemphigoid appear?

A

soft palate

42
Q

what is pemphigus vulgaris?

A

rare long-term condition caused by a problem with the immune system

43
Q

what site in the mouth does SLE typically affect? what si the typical appearance?

A

lateral borders of the tongue = striations with a lichenoid appearance

44
Q

what is erythema multiforme?

A

skin reaction that can be triggered by an infection or some medicines

45
Q

what are classical signs of erythema multiforme?

A

widespread ulceration of the vault of the palate, ulcerated lips (dry/cracked), bullae lesions on skin, bluish ring of discolouration, painful

46
Q

what is B cell non-hodgkins lymphoma

A

cancer of the lymphatic system

47
Q

what is the typical appearance of SCC?

A

ulcerated lesion with rolled border and indurated firm base
- lateral border of the tongue is a high risk site

48
Q

who is likely to have ulcerated SCC of the lower lip?

A

older pts who smoke or had a lot of sun exposure

49
Q

what type of mucosa does minor RAS tend to occur on>

A

non-keratinised (labial mucosa, floor of mouth, ventral side of tongue)

50
Q

what type of mucosa does minor RAS tend to occur on>

A

These usually appear inside the lips and cheeks, on the tongue and sometimes the floor of
the mouth.

51
Q

What is the management for oral ulceration?

A

symptomatic relief, Corsodyl mouthwash, correct reversible risk factors, anti-fungals? adjusting dentures? smoothing off teeth? referral of ulcers and systemic disease

52
Q

what type of RAS might mimic a squamous cell carcinoma?

A

Major RAS

53
Q

what is nicorandil commonly prescribed for?

A

poorly controlled/ moderately severe ischaemic heart disease (eg: angina)

CMS2 (24 decks)

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