oral ulceration

Question 1

treatment for traumatic ulceration

Answer 1

eliminate the source and review, if doesn’t resolve in 3 weeks refer

Question 2

aetiology of traumatic ulceration

Answer 2

thermal, physical or chemical trauma

Question 3

what drugs can induce ulcers? 4

Answer 3

methotrexate
nicorandil
bisphosphonates
NSAIDs

Question 4

what is methotrexate used for

Answer 4

Immune modulator: rheumatoid arthritis, psoriasis

Question 5

normally prescribed for pt taking methotrexate

Answer 5

folate supplementation

Question 6

management of methotrexate induced ulceration 3

Answer 6

Refer if suspected and lease with GP

Urgent referral if mucositis/widespread ulceration

Ask about other site involvement

Question 7

what is nicorandil used for

Answer 7

Second line prophylaxis of stable angina

Question 8

clinical features of ulcers associated with nicorandil

Answer 8

large, deep and persistent

Question 9

management of nicorandil induced ulcers

Answer 9

Refer for confirmation of diagnosis

Lease with GP/cardiology specialist to stop nicorandil treatment

Prescribe topical analgesics

Question 10

clinical features of ulcers associated with bisphosphonates

Answer 10

superficial ulceration, may be extensive

Question 11

the majority of cases of ulcers from bisphosphonates are caused by what?

Answer 11

inadequate digestion i.e. letting tablet dissolve in mouth

Question 12

what is recurrent aphthous stomatitis

Answer 12

recurrent ulcers confined to the mouth seen in the absence of systemic disease

Question 13

pathogenesis of recurrent aphthous stomatitis

Answer 13

T-lymphocyte mediates immune response

Question 14

investigations for recurrent aphthous stomatitis 4

Answer 14

Full blood count

Haematinics: ferritin, vit B12, folate

Antibodies against tissue transglutamase anti-TTG -> coeliac disease

Coeliac disease, peptic ulcer, IBD, colon carcinoma, haemorrhoids

Question 15

what are the classifications of recurrent aphthous stomatitis

Answer 15

minor, major and herpetiform

Question 16

what is this

Answer 16

minor recurrent aphthous stomatitis

Question 17

what is this

Answer 17

major recurrent aphthous stomatitis

Question 18

what is this

Answer 18

herpetiform recurrent aphthous stomatitis

Question 19

what are ulcers caused by the herpes virus called if primary infection

Answer 19

primary herpetic gingivostomatitis

Question 20

symptoms of primary herpetic gingivostomatitis

Answer 20

Initial systemic - fever, malaise
Oral vesicles that rupture leaving ulceration

Question 21

investigations to form diagnosis of primary herpetic gingivostomatitis

Answer 21

Clinical features
Swab for PCR

Question 22

what are ulcers caused by the herpes virus called if secondary infection

Answer 22

herpes labialis (cold sore)

Question 23

aetiology of mucous membrane pemphigoid

Answer 23

autoimmune

Question 24

signs and symptoms of mucous membrane pemphigoid 3

Answer 24

History of vesicles and ulceration pain that limits function

Turgid vesicles which rupture to leave areas of erosion and ulceration

May present as desquamative gingivitis

Question 25

investigations to form diagnosis of mucous membrane pemphigoid

Answer 25

biopsy

Question 26

what is this

Answer 26

mucous membrane pemphigoid

Question 27

what is the difference between mucous membrane pemphigoid and pemphigus vulgaris

Answer 27

pemphigus vulgaris involves shallow, easily ruptured blisters on the skin and mucous membranes MMP causes tense blisters that are less prone to rupture, particularly in the mouth and eyes