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51 Cards in this Set

  • Front
  • Back
Neck Swellings
Inflammatory/Infectious - Furuncle, MRSA

Benign neoplastic - Dermoid cyst, lipoma

Malignant neoplastic - Carcinoma, Adenexal tumor
Inflammatory Neck swellings
Most common - 50%

Viral - CMV, Mono
Bacterial - Parotid sialadenitis, Odontogenic infections
Parasitic - Toxiplasmosis
Granulomatous - Sarcoidosis, Scrofula
Acute or Chronic Lmphadenitis
Neoplastic Neck swellings
Second most common - 40%

Tumors of Parotid
Metastatic lesions
Developmental neck swellings
Third most common
- Branchial cleft cyst
- Epidermoid cyst
- Dermoid cyst
- Thyroglossal duct cyst
Pediatric neck masses
- 50%. Half hodgkin's Half NHL
- Thyroid cancer
- Neuroblastoma
- Nasopharyngeal carcinoma
- Alveolar soft part sarcoma
Rule of 80
Applies to 40yrs or older
- 80% neck masses are neoplastic
- 80% of neoplastic are malignant
- 80% malignant are secondary
- 80% secondary are from above the clavicle
Rule of 7
7 days - Inflammatory
7 months - Neoplastic
7 years - Developmental
Biopsy of Neck Masses
Fine needle
- Aspiration of liquid of present
- Aspiration of solid tumor for cytological specimen

Lymph node/Mass surgical biopsy
- Surgical specimen
Common location for parotid gland tumors
Lie on or behind angle of mandible and grow slowly over months or years
Oral Cancer statistics
30,000 new cases yearly
8000 Deaths yearly. More than melanoma and Cervical cancer combined
- 5 year survival rate is 50%
- Mortality unchanged for 50 yrs
Brush Biopsy technique
- Moisten brush with water
- Flat or cylindrical edge of brush placed against surface of lesion
- Apply firm pressure against surface of lesion and rotate 5-10 times
- Pink tissue or microbleeding indicates adequate depth penetration
- Spread material immediately onglass slide
- Saturate cellular material with fixative agent
- Let dry for 15-20min and ship slide
Brush Biopsy technique
- Moisten brush with water
- Flat or cylindrical edge of brush placed against surface of lesion
- Apply firm pressure against surface of lesion and rotate 5-10 times
- Pink tissue or microbleeding indicates adequate depth penetration
- Spread material immediately onglass slide
- Saturate cellular material with fixative agent
- Let dry for 15-20min and ship slide
Velscope vs Vizilite
Velscope - Normal pale, SCCa dark green or black

Vizilite - With Tblue630
- Abnormal tissue appears white
Culprits of Sialadenitis
Bacteria - Most common Staph A
- May be Strep Viridians, Haemophilus, Strep Pyogenes, E.Coli

Viruses - Mumps, HIV, Coxsackievirus, Parainfluenza
First Line agent in Dental infection
Pen VK
- Used for abscess, Cellulitis, Suppurative pulpitis, and Pericoronitis
- Food decreases drug absorption
- Do not use for prophylaxis

500mg QID x 7days

Pedo - 15-30mg/kg/day Divided into QID x 7days
2g PO 1hr prior to procedure
Penicillin Allergy Cross-reactivity
May have allergy to Cephalosporins
- 1% chance when allergic reaction is delayed
- 10-20% if theres a history of immediate reaction to penicillin
Macrolide side effects
- Altered cardiac conduction
- Hepatic impairment
- Myasthenia Gravis
- Major inhibitor of CYP3A4
Treatment for Anaerobic infections
Clindamycin above

Flagyl below
- Inhibits DNA topoisomerase
- Should not be used in pediatric patients or pregnant patients

- May have tendon inflammation and rupture even after discontinuation
Should be given on empty stomach
- Given to pediatric to treat malaria

- Can cause phototoicity and Pseudotumor Cerebri
Cobalt -60
Doesn't directly damage DNA or RNA, but forms free radicals that does
Typical treatment for SCCa and Lymphoma
200cGy 5 days a week for 6-9wks
- Total of 5000-7600cGy
- Lymphoma tx 3000-4500cGy
Implant radioactive seeds of Iridium
- More damaging to tumor
Cellular Succeptibility
Most - Germinal Lymphoreticular
Intermediate - Endothelial, Fibroblasts
Most - Muscle and nerve cells
Three H tissue
Three H tissue
Wait 21 days after extractions to begin radiotherapy
- Less likely to need maxillary exos since blood supply is greater
Golden window
3-4months after radiotherapy when acute damage has recovered and three-H tissue hasn't developed yet
- Will need hyperbaric oxygen later
Dental care for Chemo
When patient feels up to it
- Usually 17-20 days after treatment
- When granulocyte is >2000 cells/mm3
- Platelet >50,000 cells/mm3
Chemo complications
- Especially with Vincristine and Vinblastine
Oral Burning vs Burning mouth syndrome
Oral burning has underlying disease

Burning mouth syndrome has no clinical sign of disease
Oral Burning symptoms
Vitamin B deficiency - Test for B12 or Folic acid
Diabetes mellitus
GERD - Endoscopy
Hypothyroid - T3, T4, TSH
Estrogen deficiency
Burning mouth syndrome
Predilection for peri/post menopausal women
- Anterior 3rd of tongue and inside of lower lips
Salivary hypofunction
Normal 0.3-0.4ml/min
Abnormal <0.1ml/min

Normal: 1-2
Abnormal <0.5ml/min
Prediposing factors for Oral Manifestations
Viral load > 3000copies/mm3
Xerostomia, Poor OH, Smoking
Significant Oral AIDs indicators
Esophageal candidiasis
Kaposi sarcoma
Pre-HAART 50%
40% in HAART era
- Decreased OHL, NUP
- No change in Candida, oral ulcers, and KS
- Increase in HPV lesions
Angular Cheilitis
Vytone Cream 1%
Disp 15g tube
Rub into corners of mouth QID
Oral candidiasis
Mycelex Troches 10mg
Disp 70 troches
Dissolve one slowly in mouth five times a day for 2 wks
HSV Diet Modifications
- Eat more Seafood, Poultry, Eggs, Dairy, Organ meats, potatoes

- Avoid whole grains, legumes, seed containing foods chocolate, nuts

Supplement - Beta-carotene, Zinc, Lysine
Bioterrorism Categories
- Easily disseminated
- High rates of mortality
- Require special attention

Category B
- Moderately easy to disseminate
- Moderate morbidity and lower mortality

- Emerging pathogens based on availability, ease of production and dissemination, and potential for high morbidity and mortality
Smallpox incubation
7-17day incubation
- Fever and systemic complaints in 1-4 days before rash onset
Smallpox rash stages

Smallpox rash distribution vs Chickenpox
- More on extremeties and all in same stage

Chickenpox - More on trunk and all in different stages
Differenial for Smallpox
- Enteroviral infections especially HFM disease
- Disseminated HSV in immunocompromised
- Scabies, insect bites
- Molluscum contagiosum in immunocompromised
Oral Smallpox
May be first sign of disease
- Large amounts of virus released into saliva
- Highest Titer 1st week of illness
Anthrax Forms
- Papule, vesicle, ulcer
- Edema, redness and necrosis
- Most commonly encountered

- Prodromal viral like illness
- Meningitis in 50% of patients
- Extremely rare in US

- Abdominal distress with bloody vomiting or diarrhea followed by fever and signs
- Gastrointestinal illness
- Develops after ingestion of poorly cooked meat
Oropharyngeal Ulcers of Anthrax
Early - Edematous and congested

Week 1 - Central necrosis and whitish patch

Week 2 - Pseudomembrane covering ulcers
DDx for Cutaneous anthrax
Spider bite
Staph or Strep cellulitis
Ecthyma Gangrenosum
Anthrax Characteristics
- Must be exposed to spores
- Can be prevented after exposure with antibiotics
- Must enter skin, swallowed, or inhaled
- NOT spread person to person