white lesions

Question 1

what is this

Answer 1

white sponge nevus

Question 2

aetiology of white sponge nevus

Answer 2

inherited

Question 3

clinical features of white sponge nevus 3

Answer 3

white/greyish patches that blend in with surrounding mucosa
surface is folded, soft and spongy
No erythema or ulceration

Question 4

investigations of white sponge nevus 5

Answer 4

clinical features, family history, biopsy if doubt, genetic testing keratin 4/13

Question 5

management of white sponge nevus

Answer 5

explain its not malignant

Question 6

what is this

Answer 6

leukoedema

Question 7

aetiology of leukoedema

Answer 7

low grade mucosal irritation

Question 8

clinical features of leukoedema

Answer 8

milky appearance on buccal and labial mucosa, soft on palpation

Question 9

investigation of leukoedema

Answer 9

clinical features

Question 10

management of leukoedema

Answer 10

explanation and advice on potential source of irritation

Question 11

what is epitheliolysis

Answer 11

oral mucosa peeling

Question 12

aetiology of epitheliolysis

Answer 12

mucosal irritation by toothpaste, mouthwashes

Question 13

clinical features of epitheliolysis

Answer 13

strands of gelatinous milky white material removable by wiping, no significant abnormality of underlying tissue

Question 14

investigation of epitheliolysis

Answer 14

clinical features

Question 15

management of epitheliolysis

Answer 15

explanation and avoidance of sodium lauryl sulphate (SLS) containing products, cease mouthwash

Question 16

what is this

Answer 16

traumatic keratosis

Question 17

aetiology of traumatic keratosis

Answer 17

physical, chemical or thermal irritation

Question 18

clinical features of traumatic keratosis

Answer 18

white plaque not removed by wiping, may have shaggy surface, appear macerated or be associated with ridging

Question 19

investigations for traumatic keratosis

Answer 19

clinical appearance should match cause, biopsy if not clear

Question 20

management of traumatic keratosis

Answer 20

explanation, management/removal of cause, biopsy if doesn’t resolve

Question 21

what is this in a smoking pt

Answer 21

Stomatitis nicotina

Question 22

aetiology of stomatitis nicotina

Answer 22

smoking especially pipe smokers

Question 23

clinical presentation of stomatitis nicotina

Answer 23

generalised greyish/white appearance of the hard palate extending onto soft palate
Small red dots represent inflamed opening of minor salivary glands

Question 24

investigations for stomatitis nicotina

Answer 24

clinical features and history

Question 25

management of stomatitis nicotina

Answer 25

smoking cessation

Question 26

what is this

Answer 26

reticular lichen planus - lace like

Question 27

what is this

Answer 27

papular lichen planus fordyce spots are more yellow than this

Question 28

what is this

Answer 28

plaque lichen planus

Question 29

what is this

Answer 29

atrophic lichen planus

Question 30

what is this

Answer 30

Erosive lichen planus - Painful

Question 31

what is this

Answer 31

Bullous lichen planus Can burst and leave ulceration

Question 32

clinical features of lichen planus

Answer 32

symmetrical patches affecting the buccal mucosa and tongue

Question 33

investigations of lichen planus 4

Answer 33

clinical features, biopsy, swab if suspect candida, blood test if associated disease present

Question 34

management of lichen planus 6

Answer 34

-explain to pt there is no cure -controlling symptoms and suppressing flares -ask if other site involvement -adv potentially malignant -smoking cessation and alcohol moderation -baseline photographs and monitor

Question 35

aetiology of lichenoid reactions

Answer 35

iatrogenic - drugs allergy - restorative materials

Question 36

what drugs are associated with lichenoid reactions 7

Answer 36

Ace inhibitors, beta blockers, diuretics, NSAIDs, hypoglycemics, anticonvulsants, biologics

Question 37

what is this

Answer 37

lichenoid reaction - allergy to restorative material

Question 38

investigations for lichenoid reactions

Answer 38

patch testing

Question 39

management of lichenoid reaction

Answer 39

long term review as potentially malignant

Question 40

what is graft vs host disease

Answer 40

Transplanted cells attack recipients cells causing skin changes that resemble lichen planus especially in chronic cases

Question 41

what is this that mimics lichen planus

Answer 41

lupus erythematous

Question 42

what is this

Answer 42

hairy leukoplakia

Question 43

clinical features of hairy leukoplakia

Answer 43

firmly adherent corrugated surface, commonly lateral borders of tongue

Question 44

what is hairy leukoplakia associated with 2

Answer 44

AIDs and EBV

Question 45

investigations for hairy leukoplakia 2

Answer 45

biopsy, HIV testing

Question 46

what is this

Answer 46

Acute pseudomembranous candidosis (thrush)

Question 47

clinical features of acute pseudomembranous candidosis (thrush)

Answer 47

white plaques that can be removed by scraping often leaving behind an erythematous/bleeding base

Question 48

underlying predisposing factors for acute pseudomembranous candidosis (thrush) 6

Answer 48

dry mouth, steroid inhaler, anaemia, nutritional deficiency, diabetes, immunosuppressed/immunocompromised, extremes of age

Question 49

investigations for acute pseudomembranous candidosis

Answer 49

oral rinse, saliva sample, imprint culture, swab, sensitivity testing to antifungals Investigate potential underlying causes: FBC, serum B12/folate/ferritin, HbA1c, TSH

Question 50

what is this

Answer 50

chronic hyperplastic candidosis

Question 51

clinical presentation of chronic hyperplastic candidosis

Answer 51

white patches that are firmly adherent, often commissures of mouth and bilateral

Question 52

investigations for chronic hyperplastic candidosis

Answer 52

biopsy and swab

Question 53

name one aetiological factor for chronic hyperplastic candidosis

Answer 53

Cigarette smoking