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116 Cards in this Set
- Front
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secondary or metastatic stage of syphillus
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- maxulo papular rash
- oral lesions known as mucous patches that are painless, grayish and white plaques |
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tertiary syphilis
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gummas are characteristic lesions and are areas of granulomatous inflammation
- intraorally gummaas are most commonly noted on the tongue and palate. - appear as a firm nodular mass which may lead to perforation of the palatal vault and lead to a hole in the palate into the nasal cavity. |
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congenital syphilis before two years of life
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- may include bilateral symmetric mucous patches, snuffles (profuse nasal discharge containing large amounts of treponoma)
- osteochondritis or periostitis in the long bones (seen in 75-100% of children) MOTH EATEN appearance of bones at the distal ends. - can completely repair in one year. - fissures develop on the lips, nares and anus. - Rhagades - cluster of scars radiating around the mouth - mucous membranes - white mucous patches may be found on any of the membranes. |
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late manifestations of congenital syphilis
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- hutchinsons teeth - notch appearance on biting edges of upper central incisors.
- interstitial keratisis - most common late lesion - GROUND glass appearance - bony changes include sclerosing lesions, saber shin, FRONTAL BOSSING GUMMATOUS or destructive lesions in long bone. |
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hutchinsons triad
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- combo of tooth abnormalities, nerve deafness and blindness is known as hutchinsons triad.
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two tests to test for congenital syphilis
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- immunoglobin M immunoblotting and
- PCR |
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actinomycosis
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- subacute to chronic infection
- caused by filamentous gram positive anaerobic to microaerophilic bacteria that are NOT acid fast. - characterized by contiguous spread, supparative and granulomatous infl. reaction and formation of multiple abscesses and sinus tracts that discharge sulfur granules. - most common clinical forms of this are cervicofacial, thoracic and abdominal. in women pelvic actinomycosis is common. |
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cervicofacial am
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- caused by actinomyces israelii
- normally present in tonsillar crypts, carious teeth and calculus deposits. - traumatic incidents like extraction, pa infection following an open pulpitis or pericornitis around a partially impacted tooth. - infection normally follows oral surgery - initial stages are characterized by soft tissue swelling in the perimandibular area. - direct spread into adjacent tissues occurs and fistulas may form that discharge purulent material that discharge yellow. |
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mycosis
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adfadsf
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mycosis (fungal infections)
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- candidiasis
- histoplasmosis - coccidiomycosis - cryptococcosis - blastomycosis - aspergillosis - zygomycosis |
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candidiasis
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- candidosis, monoliasis, thrush
- is caused by candida albicans and presented as: yeast (spor, pseudohyphae or long and branching hyphae - the hyphal form is usually present when organisms are isolated from an infections process. |
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candidiasis general info.
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- infection of the skin or mucous membrane with any species of candida, but chiefly candida albicans.
- usually localized in the skin, nails, mouth, vagina, vulva, bronchii, or lungs but may invade the blood stream. - occurs commonly as a secondary infection ass. with immune system compromise. - newborn infants may contract through passege in the birth canal. |
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basic types of candidiasis in the oral cavity
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- acute pseudomembranous candidiasis (thrush)
- atrophic (erythematous) candidiasis - chronic hyperplastic candidiasis (candidal leukoplakia) |
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factors predisposing oral tissues to candidiasis
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- acidic saliva, xerostomia, nocturnal denture wearing, heavy smoking, blood group o individuals, immunologic disorders, antibiotic therapy, steroid therapy, iron, folic acid and vitamin deficiences.
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thrush (acute pesudomembranous candidiasis) thruch
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- a clinicla form of C. albicans infection that consists of white, creamy, loose patches of desquamative epithelium
- containing numerous matted mycelia over an erythematous mucosa that is easily removed. - common in patients with more severe predisposing factors. |
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atrophic (erythematous) candidiasis
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- clinical form of c. albicans infection in which the mucosa is thinnned, smooth and bright red with symptoms of burning and increased sensitivity.
- commonly found on the palate under a denture but also on the tongue and other mucosal surfaces. |
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chronic hyperplastic candidiasis
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- clinical form of c. albicans infection consisting of white plaques or papules againsta an erythematous background.
- containing hyphae in the parakeratin layer of the thickened epithelium. |
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oral lesions ass. with candida albicans
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- angular chelitis
- median rhomboid glossitis - chronic mucocutaneous candidiasis |
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angular cheilitis (perleche)
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- bilateral fissureof the corners of the mouth common in pt. with c albicans infections
- often requires tx. with antifungals |
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median rhomboid glossitis
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- asymptomatic, elongated erythematous patch of atrophic mucosa of the mid dorsal surface of the tongue due to a chronic c. albicans infection.
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chronic mucocutaneous candidiasis
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- condition in which persistent and refractory candidasis occurs on the musous membranes, skin and nails of the affected patients
- most patients exhibit defects in their endocrine or immune system. |
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tx. in candidiasis
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- topical or systemic antifungal medications
- elimination of the predisposing factors. |
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coccidioidomycosis
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- chronic lung infection due to inhalation of spores of coccidioides immitis common in the san joaquin valley of california that may have ass. chronic ulcers in the mouth resembling a malignancy.
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cryptococcus
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- chronic infection of the lungs ass. with bird droppings. can spread to CNS. oral chronic ulcers primarily occur in immunocompromised patients and are best treated with amph. b.
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mucormycosis: rhinocerebral zygomycosis
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- background; fungi are ubiquitous in the natural world, often found in ass. with plants, mammals andinsects.
- accordingly, humans are continually exposed to multiple genera of fungi via various routes, including the resp. and gi routes, which allow the possiblity of colonization. - depending on the interaction between host mucosal defence mechanisms and fungal virulence factors, colonization may be transient or persistent. |
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aspergillosis
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- infection commonly located in the lungs of immunocompromised patients and occasionally occuring as a destructive lesion of the maxillary sinuses
- best treated in the oral area with surgical debridement followed by amphotericin B and fluconazole fungicides and with mgmt. of the predisposing condition. |
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north american blastomycosis
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- an uncommon, rarely symptomatic, chronic lung infection due to inhalation of spores of blastomyces dermattides.
- has ass. skin lesions and occasional chronic oral ulcers that resemble malignancy and are best treated with amphotericin B. |
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types of viruses
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- dna virus (uses nuclear DNA for replication)
- RNA virus - (remains in cytoplasm) |
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latency
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- prolonged stage of some viral infections in which the viral core is integrated within cellular components, but its presence is not detectable clinically or with the use of lab methods.
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viral infections
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- herpes virus
- coxsackie virus - toga virus - paramyxovirus - human pappiloma viruses - retroviruses. |
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herpes virus
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- herpes simplex virus
- vz - epstein barr - cytomegalovirus |
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herpes viruses
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- neurotropic ( HSV 1 and 2 and VZV)
- lymphotrophic - ebv, CMV - all herpetic viruses are capable of replicating in epithelial cells. |
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herpes simplex virus
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- type 1 - oral lesions
- type 2 - genital lesions |
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herpes simplex infections
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- acute primary herpetic gingivostomatitis
- secondary or recurrent HSV infections - herpetic whitlow |
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acute primary herpetic gingivostomatitis
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- uncommon initial herpes simplex infection in which multiple shallow ulcers form.
- are present throughout both the keratinized and gland bearing intraoral surfaces. - accompanied by systemic symptoms of fever, lymphadenopathy and myalgia. |
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;rimary herpetic stomatitis
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- usually occurs in young children
- pt. has no neutralizing antibodies - child becomes very ill. |
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recurrent herpes labialis
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- episodic occurences of a cluster of vesicles and shallow ulcers localized to the lateral aspects of the lips.
- in pt. with latent herpes simplex infections dormant in ganglia that innervates the lips. - lesions are triggered by a number of internal or external factors. |
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triggering factors for clinical manifestation of recurrent herpes
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- emotional stress, trauma, cold, sunlight, gi upset, fever, menstrual cycle, immunes suppression
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herpetic whitlow
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- an intense painful infection of skin folds around the fingernails.
- caused by a direct contact with an active lesion. |
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type 2 herpes simplex genital herpies
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sick
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neonatal herpes simplex virus
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- infants bonrn to mothers with genital herpes
- involves skin, eyes, central nervous system, and internal organ. - treated with iv injection of acyclovir and supportive care. |
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tx. of herpes simplex
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- palliative and supportive like soothing rinses and analgesics
- anti viral agents like acyclovir for immunocompromised patients and genital infections. |
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herpes zoster virus
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- primary lesion is varicella or chicken pox followed by a period of latency
- during latency the virus resides in regional ganglia secondary lesions result from decreased immunity and secondary lesions may occur colled herpes zoster |
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primary varicella zoster lesion
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- acquired during childhood
- produces a maculo papular rash of the skin. - malaise, fever and minor lesions throughout the oral cavity. - contracted through close contact with other infected individuals. |
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herpes zoster (shingles )
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- regional occurnece of the vzv
- appears as vesicular eruptions of skin or mucosa - distinctive unilateral pattern - severe pain - pain persists for prolonged periods after lesions heal. (post herpetic neuralgia) |
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zoster shingles clinical signs
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- first sign is pain/ tenderness and erythematous rash.
- followed by blisters/ vesicles for 4-5 days - becomes encrusted - heals in 1-2 weeks - post herpetic neuralgia. |
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tx. of herpes zoster
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- admin. of acyclovir within 72 hours after onset of the rash.
- oral steroid to relieve the pain and post herpetic neuralgia - narcotics for post herpetic neuralgia. |
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epstein barr virus
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- ebv is a gamma herpes virus
- infects mainly b Lymphocytes - remains latent after primary infection. |
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primary diseases
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- infectious mononucleosis
- chronic ebv infection - x linked lymphoproliferative syndrome - reactivation syndrome - lympho proliferative disorders in immunocompromised patients - burkitt lymphoma - nasopharyngeal carcinoma - hairy leukoplakia. |
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diseases caused by EBV
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- mononucleosis
- hairy leukoplakia - immunoproliferative lesions and burkitt lymphoma - nasopharyngeal carcinoma |
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infectious mononucleosis
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- large lymphocytes with large nuclei.
- by means of lymphocytes ebv can gain passage to the epithelial cells of the oropharynx. - detectable antibody (IgM) to virus. |
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lymphocyte description in infectious mononucleosus
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- large and non neoplastic with a large purple core in histo analysis.
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tx. of infectious mononucleosis
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- analgesics
- rest - don't need to isolate the patient. |
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chronic ebv infection
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- seen in adults adolescents and children.
- profound debilitatieve fatigue ass. wtih low grade or subjective fever, sore throat. - weakness, myalgia, arthralgia, headache, confusion and sleep disturbance. |
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x linked lympho proliferateive syndrome (duncans disease)
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- rare x linked recessive disorder in which affected individuals develop a fatal primary infection when exposed to EBV.
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lymphoproliferative disorders in immunocompromised patients
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- immunosuppressed pt. may develop a polyclonal proliferation of EBV transformed B cells.
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burkitts lymphoma
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- form of lymphoma first described in equatorial africa that is ass. with ebv.
- has a predilection for the jaws of children. STARRY SKY APPEARANCE histologically. with macrophages and tumor cells present. |
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nasopharyngeal carcinoma
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- aggressive form of SCC in the nasopharynx
- having varying levels of differentiation. - often first discovered as a metastatic lesion in a lateral neck lymph node. - undifferentiated forms of this tumor are ass. with EBV. |
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hairy leukoplakia
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- vertically corrugated, slightly elevated WHITE surface alteration of the LATERAL or VENTRAL tongue margin.
- does not wipe off and can't be seen at other oral sites, usually in conjunction with tongue lesions. - treated with chemotherapy |
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coxsackie virus
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- part of picornavirus (includes common cold virus) family.
- RNA virus - 2 types - A (affecting oral region) and B affecting epithelial tissue of oropharynx. |
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lesions ass. with coxsackie viruses
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- herpangina
- hand, foot and mouth diseases - acute lymphonodular pharyngitis. |
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herpangina
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- non treatable mild infection caused by a mixture of cox. a viruses
- localized to the post. soft palate and nasopharynx. - consist of multiple small shallow ulcers resembling a herpetic infection that lasts for approx. one week. |
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hand foot and mouth disease
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- a highly contagious systemic infection of cx a virus
- limited duration in which vesicular eruptions occur in the palms of hands, soles of feet, and mucosa of ant. part of the mouth. |
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hand foot and mouth gen. info.
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- incubation period of 3-5 days
- dispersed vesicles, 5-10 in number. - 2-6 mm in diameter surrounded by red halo. - rupture quickly, leaving painful ulcers. - present for 5-8 days. - vesicles found intra dermally, consisting of epidermal exocytosis, spongiosis, and individual cell necrosis. |
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acute lymphonodular pharyngitis
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- localized infection of cox a virus
- consisting of yellow or white papules surrounding an erythematous zone confined to the lymphoid tissues. - post. soft palate and nasopharynx that lasts from 1-2 weeks. |
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togavirus (rubella)
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german measles
- systemic viral infection - begins in resp. tract and moves to circ. system. - produces a papular skin rash, fever and malaise that lasts for 1-2 weeks. - capable of producing congenital defects during pregnancy. |
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paramyxovirus
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- measles (rubeola)
- mumps (epidermic parotitis) |
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measles (rubeola)
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- highly contagious systemic viral infection
- crontracted through the resp. system and spread through the circ. system. - predilection for skin blood vessels that produce a skin rash. - sometimes pneumonia and encephalitis. |
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spots in measles
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KOPLICK SPOTS - typically involve the buccal and labial mucosa.
- irregular patchy, erythema with a central, minute bluish white specks with the appearance of a grains of salts. |
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mumps
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- acute viral illness
- until recently only thought to affect armies during times of mobilization - incubation period is 14-18 days (range of 14-25 days) - the prodromal symptoms are non specific, and include myalgia, anorexia, malasie, headache and low grade fever. |
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mumps - epidemic parotitis
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- localized viral infection contracted through the resp. system.
- primarily affects one or more major salivary glands. - swelling and pain - occasionally affects other organs; and produces fever and malaise. |
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mumps continued
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- parotid gland involvement (parotitis)
- common 90% bilateral - painful due to the stretching of the parotid capsule - lasts for 3-4 days - displaces the ear lobe due to involvement of the tail of the parotid gland. - may even cause trismus in extreme instances - may cause the skin overlying the parotid gland to be warm and flushed BUT ther is NO rash. |
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mumps cont.
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- clinical swelling of the submand. glnds is much less frequent ( 10%)
- symptomatic sublingual gland involvement is uncommon. - can involve a wide range of different tusses and organs. - meningitis is common, but is typically mild - orchitis - may dev. 4-5 days after the parotitis. - generally only occurs in post pubertal males and rarely causes sterility. |
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serious complications of mumps include
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- deafness
- encephalitis mumps is a self limiting disease in most cases. - no specific anti viral therapy mgmt. is supportive. |
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human papilloma virus (HPV)
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- part of DNA papovavirus family
- there are 100 HPV subtypes - tropism for epithilial cells - are found in normal mucosa in a late stage, and in benign and malignant lesions. |
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HPV in benign oral lesions
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- squamous papilloma (hpv 6 and 11)
- verruca vulgaris ( HPV 2 and 4) - condyloma acuminatum (hpv 6 and 11) - focal epithelial hyperplasia ( HPV 13 and 32) |
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squamous papilloma
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- papillary focal epithelial hyperplasia common in the post. aspect of the mouth, containing koilocytic cells and HPV 6 and 11
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papilloma
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- benign epithelial enlargement that is ass. with human papilloma virus infection.
- firm, nonpainful, and pedunculated - rough white cauliflower or warty surface with numerous fingerlike projections. - arises from surface of sse, is exophytic and it does not invade underlying tissues. - excisional biopsy including the base of the lesion is the tx. - recurrence is unlikely. |
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mumps - epidemic parotitis
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- localized viral infection contracted through the resp. system.
- swelling and pain - primarily affects one or more major salivary gland. |
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mumps epidemic parotitis
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- can involve a wide range of different tissues and organs
- meningitis is common but mild usually. - orchitis - may develop 4-5 days after the parotitis. rarely causes steriolity. |
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papilloma
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- a benign epithelial enlargement ass. with HPV infection.
- firm, nonpainful and pedunculated - rough white cauliflower or warty surface with numberous fingerlike processes. |
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veruca vulgaris (wart)
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- papillary focal epithelial hyperplasia commonly containing koilocytic cells of HPV 2 or HPV 6
- commonly occurs on hands and ant. aspect of mouth of kids. |
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veruca vulgaris cont.
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- asymptomatic, exophytic and broad base.
- surface is white rough and warty - may be solitary or multiple - may spread to other body surfaces via autoinoculation. - sometimes spontaneously resolve. - usually treated by liquid nitrogen, chemical agents or surgical excision. - ORAL verruca are treated by excisional biopsy. |
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condyloma acuminatum
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- multiple papillary or sessile focal areas of epithelial hyperplasia
- genital and oral mucosa that contain koilocytes and HPV 6- HPV 11 - hard to get rid of. |
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statistics on HPV infection
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- 20% of women are infected with HPV.
- cervical cancer is the second leading cause of cancer among women. 95% of cervical cancers contain HPV DNA |
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transmission of HPV
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- similar to other diseases regarding other venereal diseases.
- high correlation, therefore between number of sex partneers and risk of infection. |
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condyloma accuminatum
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- warty soft tissue enlargemet caused by HPV
- sexually transmitted and most common in the anogenital region. - often has multiple lesions. - TREATED BY SURGICAL EXCISION - pat. sexual partner should also be treated. |
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focal epithelial hyperplasia (multifocal epithelial hyperplasia, heck disease)
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- multiple papillary or sessile areas of epithelial hyperplasia of the oral mucosa.
- in young patients of specific pop. isolates that frequently regress spontan. - the epithelium is extensively acanthotic and contains koilocytes and HPV 13 and HPV 32. |
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focal epithelial hyperplasia exceptions
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- characterized by acanthosis, with the presence of mitosoid cells which presumably reflect the presence of the causative virus.
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retrovirus
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HIV causes aids -
- the virus can enter the body through the lining of the vagina, vulva, penis, rectum or mouth during sex. - may also be spread through infected blood |
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aids transmission to babies
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- about 1/4 to 1/3 of all women infected with HIV and untreated will pass the disease on to their children.
- can also be spread through the breast milk. - mother should be on AZT therapy to reduce transmission problems. |
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early symptoms of HIV infection
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- fever, headache, tiredness and enlarged lymph nodes.
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cdc's def. of aids
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- hiv infected people who have fewer than 200 CD4 positive T cells per cubic millimeter of blood. (healthy adults usually have CD4 positive counts of more than 1000)
- 26 clinical conditions that affect people with adva nced HIV disease. most are opportunistic infections. |
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symptoms of opportunistic infections common in people with aids include...
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coughing and shortness of breath.
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how to diagnose HIV
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two tests
1. Elisa 2. western blot |
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elisa test
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- enzyme linked immuno sorbent assay.. is a relatively inexpensive and very accurate test (though not 100 percent)
- in this test (generally the first test performed) a blood sample is taken and spun at high speeds allowing serum to seperate from blood. - then a reagent is added that changes color to indicate HIV infection. |
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western blot test
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- confirms the elisa test findings if they are positive.. because it is expensive.
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infections and neoplastic lesions ass. with aids
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- pneumocystis carinnii pneumonia
- cryptosporidiosis - toxoplasmosis - cerebral meningitis - kaposi sarcoma - non hodgkins lymphoma. - generalized herpes simplex/ vzv infections - cmv retinitis - candidiasis |
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common oral lesions in patiens with AIDS
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- candidiasis
- intraoral - esophogeal - hairy leukoplakia - diffuse herpes simplex gingivostomatitis - diffuse varicella zoster lesions - kaposi sarcoma - non hodgkin lymphoma - hiv gingivitis / periodontitis - acute nonspecific ulcers - chronic ulcers - cryptococcus neoformans - histoplasma capsulatum - cmv - herpes simplex |
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kaposi sarcoma
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- macular or nodular vasc. lesions occuring singularly or in multiples on the mucosa and skin of HIV infected patients; lesions consiste of proliferating atypical endothelial cells and indicate that the patient has aids.
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tx. of HIV infection
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- RT inhibitors - interrrupts early stage of the virus making copies of itself.
- included in this class of drugs are AZT - may slow the spread of HIV in the body and slow the start of opportunistic infections. - second class is known as protease inhibitors ... interupt virus replication at a later stage in their life cycle. all end in - vir. |
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features of benign tumors
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- slow growth , encapsulated , well defined, non ulcerated, no metastasis.
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malignant tumors
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- differ from benign tumors in 4 different ways
1. structure 2. rate of growth 3. invasive growth 4. metastasis - metastasis is a unique feature of malignant tumors. |
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features of malignant tumors
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- list on slide 10 of epithel.
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experimental carcinogenesis
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- initiation - alteration in genome occurs
- promotion - event that causes proliferation of the tranformed cell, giving rise to a neoplasm. - progression - new genetic mutation occurs with dev. of sub clones of neoplastic cells. |
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histological chanegs in malignant neoplasm
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- pleomorhism - variation in cell and nuclear size and shape.
- hyperchromatism - inc. nuclear DNA - abnormal mitosis - increased mitosis - anaplasia - loss of morphologic evidence of maturation. |
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epithelial disorders (lesions of oral epithelium)
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- benign epithelial tumors
- benign pigmented lesions - epithelial hyperplasia/ atrophy/ dysplasia and malignant epithelial tumors and melanoma. |
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benign epithelial lesions
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- squamous papilloma
- keratoacanthoma |
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papilloma
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- slow growing caused by HPV 6 and 11
- no potential for malignancy and removed by local excision. |
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other HPV related epithelial lesions caused by different subtypes of the virus ...
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- verrucous vulgaris
venereal wart (condyloma accuminatum) - focal epithelial hyperplasia |
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focal epithelial hyperplasia
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ass. with HPV
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keratoacanthoma
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- benign endophytic epithelial growth
- appearing as a well circumscribed keratin filled crater - on sun exposed skin - often mistaken for squamous cell carcinoma. - surgical tx. |
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benign pigmented lesions
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- melanotic macules
- smokers melanosis - nevi - intramucosal (intradermal) nevus - junctional nevus - compound nevus - blue nevus |
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melanotic macules
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- physilogic or reactive small, flat brown areas of the mucosal surface
- caused by an increase in the production of melanin granules - not in the number of melanocytes. |
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nevi
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- benign, exophytic, usually pigmented congenital lesion of the skin or mucosa.
- composed of focal collections (nests) of rounded melanocytes (nevus cells) - surgical excision of oral nevi. |
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nevus: birth mark, mole
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- dependingon location of the nevus cells, specific lesions are classified.
- intradermal (intramucosal) - junctional - compound - a macular form, usually of the hard palate and composed of fusiform cells, is termed blue nevus. |