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Flashcards in Pathology4 Deck (61):
1

Which of the following make up the triad of Stevens-Johnson syndrome (SJS)?
• stomatitis
• lesions of the eye
• genital lesions
• maculopapular rash

• stomatitis
• lesions of the eye
• genital lesions
an immune-complex—mediated hypersensitivity complex that is a severe expression of erythema multiforme. It is now known also as erythema multiforme major

2

pathognomonic of Stevens-Johnson syndrome?

bull's-eye-shaped" target lesions (Blindness can occur due to secondary infection)

3

The lesion is a small (2 mm-5 mm in diameter), whitish sore with a red border.The patient states that it usually begins as a reddish area with a burning or tingling sensation. The most likely diagnosis is:

recurrent aphthous minor

4

Erythema multiforme (EM) is an acute self-limited eruption characterized by a distinctive clinical eruption, the hallmark of which is the:
• chronic desquamative gingivitis
• petechial hemorrhage
• iris or target lesion
• mucocutaneous rash

iris or target lesion — appears as a central lesion surrounded by concentric rings of pallor and redness over the dorsal aspect of the hands and forearms

5

The diagnosis of Erythema multiforme is primarily based on ?

the classic skin lesion appearance

6

Behcet syndrome is a rare disorder that causes chronic inflammation in ?. Manifestations include ?. Treatment with ? and other immunosuppressive drugs prevents serious complications, such as blindness.

• blood vessels throughout the body
• oral and genital aphthous-type ulcers, conjunctivitis, uveitis, arthritis, headache, and other CNS symptoms
• corticosteroids

7

A 43-year-old man presents to the ER with a purple lump of the jaw that is painful. He has an extraoral sinus tract presenting with yellowish crust. The ER places the individual on a long-term penicillin regimen. What was the most likely diagnosis?
• coccidioidomycosis
• histoplasmosis
• tuberculosis
• actinomycosis
• scarlet fever

actinomycosis (lumpy jaw is used)

8

Histoplasmosis is a chronic lung infection caused by inhalation of spores of Histoplasma capsulatum. It is endemic to the American Midwest. The classic oral manifestation of histoplasmosis infection is ?

a chronic nonhealing ulcer

9

Scarlet fever is a systemic infection caused by Streptococcus pyogenes. It is characterized by pharyngitis, fever, malaise, and its oral manifestation is ?

strawberry tongue (has a white coating with red, inflamed fungiform papillae)

10

Treportema pallidum is the infectious organism of which disease?
• syphilis
• gonorrhea
• chlamydia
• tuberculosis

syphilis

11

An oral manifestation of gonorrhea is ?

oral pharyngitis

12

name dental defects seen in congenital syphilis are caused by direct invasion of tooth germs by Treponema organisms?

"Screwdriver" incisors (hutchinson incisors) and "Mulberry molars"

13

Which of the following fungal infections is most commonly associated with diabeites mellitus?
• coccidioiodomycosis
• mucormycosis
• aspirgillosis
• zygornycosis

mucormycosis

14

A 4-year-old patient comes with her mother for a routine appointment. The mother states that her daughter just started not feeling well and had a mild fever earlier in the day. The daughter has been having trouble swallowing. An intraoral exam reveals multiple 1-mm to 2- mm vesiculopapular lesions of the nasopharynx and soft palate. Your working diagnosis is:
• herpangina
• hand-foot-and-mouth disease
• herpes simplex infection
• pemphigus vulgaris

herpangina

15

• herpangina
• Type 1 Herpes

• the ulcerations of herpangina are localized to the posterior soft palate and nasopharynx
• lesions are found typically more forward in the mouth on the tongue, gingiva, and buccal mucosa and appear as vesicles (small, clear blisters that ulcerate and crust) around the mouth and on the lips.

16

Hand-foot-and-mouth disease is a highly contagious systemic infection of limited duration in which vesicular eruptions occur on the palms of hands, soles of feet, and mucosa of the anterior part of the mouth. It is ? in the oropharyngeal area (unlike herpangina).

uncommon

17

Which type of herpes virus is associated with the lesion on the lower lip?
• HSV-1
• HSV-2
• HSV-3
• HSV-4

HSV-1 (The majority of oral herpes cases are caused by HSV-1 and the majority of genital herpes cases are caused by HSV-2.)

18

Herpetic lesion on the finger is called ?

herpetic whitlow

19

The dormancy state with latency in trigeminal ganglion is associated with which form of herpes?
• cytomegalovirus
• epstein-barr virus
• herpes simplex virus type 1
• herpes simplex virus type 2

herpes simplex virus type 1

20

? are a manifestation of recurrent HSV infection around the mouth. The most common site is on ?

• Cold sores
• the lips

21

The characteristic cells of the herpetic lesion are known as:
• lipschutz bodies
• civatte bodies
• lisch nodules
• reed-sternberg cells

lipschutz bodies

22

A 65-year-old man presents to your clinic in regards to upper dentures. When getting his health history, you ask about history of infectious diseases. He mentions that a year ago, his eldest son died and later he broke out in blisters on only half of his back. He says he doesn't remember what the doctor called it, but he remembers the physician saying it "stopped at the midline." What is the most likely diagnosis?
• herpes zoster
• herpangina
• recurrent herpes
• chickenpox

herpes zoster (the virus causes the disease chickenpox (varicella) and shingles (herpes zoster))

23

The histology for both chickenpox and shingles shows ? as seen in herpes simplex

the same cytopathic effect

24

Over 90% of primary herpes simplex viral infections are:
• manifested as ANUG
• associated with HIV
• subclinical
• characterized by severe lymphadenopathy and acute dermatitis

subclinical (flu-like symptoms)

25

The treatment of herpes simplex is ? and aimed toward the relief of the acute symptoms so that fluid and nutritional intake can be maintained. Corticosteroids are ? in patients with herpes simplex infections

• supportive
• contraindicated

26

After the initial primary attack during the early childhood period, the herpes simplex virus remains inactive most commonly in the:
• geniculate ganglion
• ciliary ganglion
• trigeminal ganglion
• pterygopalatine ganglion

trigeminal ganglion (will often reappear later as the familiar "cold sore," usually on the outside of the lips. This disease is referred to as "recurrent herpes labialis")

27

A 49-year-old patient: of Ashkenazi heritage presents to your office complaining of "blisters in her mouth". Your intraoral exam shows ulcers present on multiple areas of mucosa. She also related to you that, while getting out of the car earlier, her skin of her arm rubbed against the car door and tore. Known as Nikolsky sign, this phenomenon is associated with which disease?
• herpes zoster
• lupus erythematosus
• lichen planus
• pemphigus

pemphigus (antibodies against the desmosomal adhesion molecule Dsg3 resulting in severe mucosal erosions and epidermal blistering, this disease is fatal without therapy)

28

The oral lesions of benign mucous membrane pemphigoid most commonly present as a:
• candidiasis
• hairy leukoplakia
• desquamative gingivitis
• hemorrhagic mass

desquamative gingivitis (sloughing during eating or tooth brushing)

29

? sign, which is an indication of pemphigus vulgaris (most common type of pemphigus), may also be found in benign mucous membrane pemphigoid

Nikolsky sign (apparently normal epithelium may be separated at the basal layer and rubbed off when pressed with a sliding motion)

30

in pemphigus vulgaris there is intercellular edema and loss of intercellular bridges with loss of cohesiveness. This is called ?. Clumps of cells are often found floating free in the vesicle space

acantholysis

31

? sign, which is an indication of pemphigus vulgaris (most common type of pemphigus), may also be found in benign mucous membrane pemphigoid

Nikolsky sign (apparently normal epithelium may be separated at the basal layer and rubbed off when pressed with a sliding motion)

32

major difference between benign mucous membrane pemphigoid and pemphigus vulgaris is that the vesicles in benign mucous membrane pemphigoid are ? in pemphigus vulgaris vesicles are ?

• subepidermal and there is no evidence of acantholysis
• suprabasilar and there is acantholysis (Usually pemphigus vulgaris causes the tissue to rupture or slough before a vesicle has time to form or is clinically apparent)

33

The common wart or verruca vulgaris is caused by the:
• human papillomavirus
• adenovirus
• epstein-Barr virus
• human parvovirus

human papillomavirus (wart is a cauliflower-like, sessile, soft lesion)

34

A 45-year-old female walks into your office complaining of a "wart" on her gums that has been there for years. Your exam reveals an asymptomatic, well circumscribed, slightly raised, papillomatous lesion on the buccal gingiva of tooth #5. A likely diagnosis of this is:
• fibrosarcoma
• neurosarcoma
• lipoma
• verruciform xanthoma

verruciform xanthoma (etiology is unknown)

35

A 63-year-old completely edentulous patient comes into your office because her dentures have "finally gotten too bothersome to wear." Her health history consists of COPD and cigarette 40-year pack history. Your intraoral exam reveals a noxious odor and an ill-fitting upper denture. When you remove the upper denture you note multiple red, papillary projections of the hard palate. Your patient states she does not remove her dentures at night or between meals. After reviewing denture hygiene instructions, you give her the diagnosis of:
• epulis fissuratum
• papillary hyperplasia
• nicotinic stomatitis
• kaposi sarcoma

papillary hyperplasia (etiology is both ill fitting denture and poor oral hygiene)
(epulis fissuratum etiology is ill fitting denture located in the vestibular mucosa where the denture flange contacts tissue)

36

relationship of any of the fibrous hyperplasias (papillary hyperplasia or epulis fissuratum) and malignancy?

There is no malignant potential

37

a benign epithelial neoplasm that appears as a pedunculated, whitish cauliflower-like mass on the lower lip. The most likely diagnosis is?

papilloma

38

? is a frequent tumor of skin analogous to the oral papilloma

The common wart, or verruca vulgaris

39

A fibroma is a benign neoplasm of ? origin

connective tissue origin

40

A 54-year-old African-American female presents to your clinic for an initial exam. She has a history of hypertension controlled with beta-blockers but no other contributory health findings. Your intraoral exam reveals a bilateral filmy opalescence of the buccal mucosa. When stretching out her cheeks, this white hue disappears. Your most likely diagnosis is:
• squamous cell carcinoma
• fordyce granulation
• leukoedema
• leukoplakia

leukoedema (most noticeable along the occlusal line in the bicuspid and molar region, simply a variant of normal mucosa and no treatment is necessary)
Leukoplakia would not disappear when stretched

41

? (SP) is a form of hyperkeratosis with various degrees of clinical manifestation (i.e., white mucosal change). SP develops on those mucosal sites where the tobacco is held.

Snuff pouch

42

A 67-year-old Caucasian male comes into your office for a routine check-up. He relates to you that he just got back from Florida where he goes for the fall and winter months. He enjoys taking his boat out with his wife. Your extraoral exam shows chapped lips, but his lower lip also presents with grayishwhite plaques. There is marked loss of elasticity of the vermillion border. Which of the following would you make your diagnosis:
• actinic keratosis
• actinic cheilitis
• actinic dermatitis
• solar lentigo

actinic (solar) cheilitis (a variant of oral leukoplakia, irreversible damage, considered premalignant and may lead to squamous cell carcinoma)

43

An incisional biopsy is indicated for which of the following lesions?
• a 0.5-cm papillary fibroma of the gingiva
• a 0.2-cm exostosis of the hard palate
• a 0.2-cm area of Fordyce'disease of the cheek
• a 0.3-cm hemangioma of the tongue
• a 0.3-cm area of leukoplakia of the soft palate

a 0.3-cm area of leukoplakia of the soft palate (In all cases, leukoplakia must be completely excised since diagnosis for malignancy cannot be made clinically)

44

ectopic sebaceous glands in the buccal mucosa and/or lip. They are present in over 75% of adults. They usually appear as yellow, sometimes yellow-white?

Fordyce disease (or granules)

45

When mechanical irritation produces a white lesion it is called ?

frictional keratosis

46

You are conducting a routine exam on a 54-year-old patient with diabetes mellitus type 2 and a 20-year pack history of smoking. You see a white patch on left alveolar edentulous ridge. The lesion cannot be wiped off and the patient denies a history of trauma or allergies. Which of the following would be your diagnosis?
• squamous cell carcinoma
• lichen planus
• erythroplakia
• leukoplakia

leukoplakia (Possible etiologic factors include tobacco, alcohol, and oral sepsis. It is most often due to tobacco use. Some investigators believe that pipe smoking is most harmful.)

47

A 75-year-old patient comes to your office wanting a new set of dentures. She hasn't been wearing her old dentures for about 2 years. She has a collapsed VDO and her physician is concerned about her iron deficiency. The corners of her mouth are fissured, dry, and erythematous. Which of the following conditions is the likely diagnosis?
• squamous cell carcinoma
• angular cheilitis
• verruca vulgaris
• stornatitis nicotina

angular cheilitis — also called perleche

48

A 34-year-old male comes into the clinic for an initial exam. Your health history is noncontributory. The patient presents with bilateral asymptomatic, white, folded and spongy tissue on the buccal mucosa. There is no history of cheek biting, and the patient recalls that the lesions have been present as long as he can remember. You diagnosis is:
• hyperkeratosis
• leukoplakia
• epidermolysis bullosa
• white sponge nevus

white sponge nevus (There is no treatment for white sponge nevus, however, since the condition is perfectly benign, the prognosis is excellent. There are no serious clinical complications)

49

white sponge nevus is often mistaken for ?

leukoplakia

50

? is an abnormal increase in the thickness of the keratin layer (stratum corneurn) of the epithelium. It is one of the most common white cheek lesions of the oral mucous membranes (often in an area of chronic cheek biting) and presents as being thick and scaly.

Hyperkeratosis

51

Hairy tongue is a condition characterized by hypertrophy of the:
• filiform papillae
• fungiform papillae
• circumvallate papillae
• foliate papillae

filiform papillae (associated with poor oral hygiene, extended use of antibiotics, corticosteroids, hydrogen peroxide, and smoking)

52

filiform papillae are characterized by ?

the absence of taste buds and increased keratinization

53

Fungiform papillae are found mainly at ?

the tip and lateral margins of the tongue

54

A 62-year-old African-American female patient presents to your clinic for routine dental work. Your intraoral exam reveals white, lacelike webbing on the buccal mucosa. Your patient has never noticed these and they have never caused her a problem. You suspect the following:
• lupus erythematosus
• erythema multiforme
• pemphigus vulgaris
• lichen planus

lichen planus (These lacelike white striae, the so-called Wickham striae, are a classic presentation of lichen planus. They are often bilateral and symmetrical in distribution)

55

The microscopic appearance of lichen planus is characteristic and pathognomonic:
• ? with thickening of the granular cell layer
• Development of a ? appearance of the rete pegs
• ? of the basal layer of cells
• Infiltration of ? into the subepithelial layer of connective tissue

• Hyperparakeratosis
• "saw tooth"
• Degeneration
• inflammatory cells

56

A white patch that, when scraped or removed from the oral mucosa, leaves a raw, bleeding surface most likely is:
• leukoplakia
• white sponge nevus
• candidiasis
• lichen planus

candidiasis (Oral candidiasis, also known as thrush, nystatin as mouth wash)

57

C. albicans can cause ?

both angular cheilitis (Perleche) and candidiasis

58

chewing betel quid and smokeless tobacco increases the risk of ?

verrucous carcinoma

59

Stomatitis nicotina is related to pipe smoking (as well as cigar smoking) and occurs exclusively on the palate. It affects males predominantly. The palate first appears red and inflamed. Soon it develops a diffuse, grayish-white, thickened, multinodular papular appearance with a small red "spot" in the center of each tiny nodule. This "spot" corresponds to ?

the orifices of palatal salivary gland ducts

60

A 35-year-old healthy female presents to your office for routine dental work. While completing the restorative treatment on the LL quadrant, you notice that her tongue has multiple irregularly shaped red lesions that have a white border. You make a note in your chart. When she returns 2 weeks later for the restorative work on the LR quadrant, you note that there are still lesions, but in different locations on the tongue with different shapes. What is your diagnosis?
• fissured tongue
• macroglossia
• geographic tongue
• hairy tongue

geographic tongue (also called erythema migrans, desquamation of the filiform papillae)

61

Fissured tongue is characterized by ?

a deep median fissure with laterally radiating grooves