White Patch

Question 1

What is dysplasia?

Answer 1

Abnormal change in structure, differentiation and cellular appearance of epithelium

Question 2

What is atypia?

Answer 2

Cellular changes that occur due to dysplasia

Question 3

Differential diffuse white patch buccal mucosa?

Answer 3

Leukoplakia
Lichen planus
Frictional-keratosis
Leukoedema

Question 4

What might see in dysplasia?

Answer 4

Epithelium invading connective tissue

Question 5

If suspect hyperkeratosis how manage?

Answer 5

Identify cause of trauma
Remove
If lesion regress = diagnosis confirmed

Question 6

What does non-homogenous mean?

Answer 6

Not only diff colour e.g red and white but also variation in thickness?

Question 7

What is a drop shaped rete peg?

Answer 7

Tear dropped shape - narrow stalk wider as extend into CT

Question 8

What histological changes may see in dysplasia?

Answer 8

APHID Behind U

Infiltration of neutrophil
Area ulceration
Nuclear cellular pleomorphism
Basal compartment orientation lost 
Disordered epithelium 
Abnormal cell division
Hyperchromatism

Question 9

What is nuclear cellular pleomorphism?

Answer 9

Variation of shape and size of cells

Question 10

What see is abnormal cell division?

Answer 10

Increased number of cells undergoing mitosis

Question 11

What is hyperchromatism?

Answer 11

Cells stain darks due to genetically abnormal increase DNA

Question 12

What expect to see in severe dysplasia?

Answer 12

Epithelium fully abnormal from basement membrane to surface

Question 13

Issue w/ severe dysplastic lesions?

Answer 13

High risk of progression to malignancy

Question 14

Pt management of dysplasia?

Answer 14

Excision
Reduce RFs: smoking/alcohol
Monitor

Question 15

What are chronic inflammatory cells?

Answer 15

Lymphocytes and plasma cells

Question 16

How identify neutrophil?

Answer 16

Multi-lobed nuclei

Question 17

What additional test would do if suspect candida?

Answer 17

PAS stain - periodic acid Schiff stain

Question 18

Why are neutrophils present CHC?

Answer 18

Candida is irritant

Question 19

How does PAS identify candida?

Answer 19

Stain polysaccharide in cells walls of candida magenta

Question 20

What expect CHC lesion look like clinically?

Answer 20

Reasonably well-defined white patch at commissure of mouth
Non-homogenous - mixed white and red lesion
Non uniform in appearance - appear thicker

Question 21

What see is histology of CHC?

Answer 21

Branching hyphae candida within keratinised tissue

Hyperplastic epithelium

Question 22

Where see candida in epithelium?

Answer 22

Keratin layer

Question 23

What other stain can be used to identify candida?

Answer 23

Silver stain

Question 24

What is significant of diagnosis of CHC?

Answer 24

Potentially malignant

Want to check for dysplasia

Question 25

Management of CHC?

Answer 25

Remove cause - candidia Topical antifungal Systemic antifurncal - fluconazole

Question 26

What interacts w/ fluconazole?

Answer 26

Warfarin

Question 27

What other tests may be useful if diagnose CHC?

Answer 27

Full blood count | Random blood glucose - can be first sign diabetes

Question 28

What features may see in SCC clinically?

Answer 28

High risk site: lateral border tongue, floor mouth, retromolar region Raised, rolled borders Non-homogenous Ulcerated/ erosive lesion

Question 29

What cytological changes see histologically in SCC?

Answer 29

``` Invasion - islands epithelium into CT Nuclear and cellular pleomorphism Hyperchromatisis Abnormal division - mitotic figures Disorganisation ```

Question 30

Management of pt w/ SCC?

Answer 30

Excision MRI scan - size tumour and check metastasis Reconstruction if necessary

Question 31

Possible causes for enlarged lymph node in neck?

Answer 31

Infection - dental, URTI | Malignancy

Question 32

What features of enlarged lymph node would help w/ diagnosis?

Answer 32

Tender? - if so likely infected Mobility Texture

Question 33

How expect lymph node appear in malignancy?

Answer 33

Painless, firm, hard, lack of mobility