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404 Cards in this Set
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Oral Infections
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What is the most common type of oral change?
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Aphthous Minor
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Minor, Herpetiform, or Major Aphthous: Lowest recurrence rate of the three types.
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Aphthous Minor
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Minor, Herpetiform, or Major Aphthous: Childhood/Late teens - 20s
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Aphthous Minor and Major
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Minor, Herpetiform, or Major Aphthous: Affects more females than males
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All three
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Minor, Herpetiform, or Major Aphthous: Affects 20% of the general population
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Aphthous Minor
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Minor, Herpetiform, or Major Aphthous: Affects non-smokers
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Aphthous Minor and Major
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Minor, Herpetiform, or Major Aphthous: Caused by - Inherited and immunodysregulation, mucosa decrease, and antigen increase
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Aphthous Minor and Major
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Minor, Herpetiform, or Major Aphthous: Trauma, stress, allergies provoke them
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Aphthous Minor and Major
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Minor, Herpetiform, or Major Aphthous: Single and maybe Multiple, but no more than 3-5 at once
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Aphthous Minor and Major
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Minor, Herpetiform, or Major Aphthous: Non-keratinized sites
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Aphthous Minor
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Minor, Herpetiform, or Major Aphthous: Lasts 5 days - 2 weeks
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Aphthous Minor
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Minor, Herpetiform, or Major Aphthous: Tx is Antibiotics and topical corticosteroids, Levamisole
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Aphthous Minor
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Minor, Herpetiform, or Major Aphthous: Looks a lot like herpes simplex
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Herpetiform Aphthous
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Minor, Herpetiform, or Major Aphthous: Most number of lesions of the three types
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Herpetiform Aphthous
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Minor, Herpetiform, or Major Aphthous: Most frequent recurrence of the three types
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Herpetiform Aphthous
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Minor, Herpetiform, or Major Aphthous: Young adults
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Herpetiform Aphthous
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Minor, Herpetiform, or Major Aphthous: Multiple, 50-100 at once
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Herpetiform Aphthous
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Minor, Herpetiform, or Major Aphthous: Sometimes on keratinized surfaces
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Herpetiform Aphthous
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Minor, Herpetiform, or Major Aphthous: Lasts 7-10 days, with recurrence
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Herpetiform Aphthous
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Minor, Herpetiform, or Major Aphthous: Tx is topical steroids
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Herpetiform Aphthous
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Minor, Herpetiform, or Major Aphthous: 2nd most common of the three types
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Aphthous Major
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Minor, Herpetiform, or Major Aphthous: Longest duration of the three types
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Aphthous Major
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Minor, Herpetiform, or Major Aphthous: Very painful, may scar because they are large and deep
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Aphthous Major
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Minor, Herpetiform, or Major Aphthous: Most common on labial mucosa and soft palate
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Aphthous Major
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Minor, Herpetiform, or Major Aphthous: Lasts up to 6 weeks, with recurrence
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Aphthous Major
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Minor, Herpetiform, or Major Aphthous: Cannot be treated with antibiotics
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Aphthous Major
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Minor, Herpetiform, or Major Aphthous: Tx is Non-systemic steroids, Orabase-Kenalog, Decadron, topical Tetracycline
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Aphthous Major
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Other than viral respiratory infections, what is the most common viral disease that affects humans?
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Herpes Simplex I and II
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What is the primary mode of transmission, during a/symptomatic?
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Asymptomatic
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What is another name for primary herpes simplex?
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Acute Herpetic Gingivostomatitis
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When does Primary herpes simplex usually occur?
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1-5 years old
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Which features ulcers on the gingiva: Aphthous ulcers or primary herpes simplex?
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Primary Herpes simplex
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Name the only place that Recurrent Intraoral Herpes Simplex can occur.
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Mucosa that is bound to periosteum (gingiva and hard palate)
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What often causes Recurrent Intraoral Herpes Simplex?
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Dental treatment
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Name the two diseases caused by varicella-zoster virus.
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1 Chicken pox 2 Shingles
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How does varicella-zoster usually enter the body?
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Respiratory tract
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Name the maculopapular eruption that occurs on the trunk and face first, then extremities.
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Chicken pox
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What are the oral manifestations of chicken pox?
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Small vesicles on buccal mucosa, palate, and gingiva
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Name the 3 type of aphthous.
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1 Minor 2 Major 3 Herpetiform
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T/F: Aphthous is more common in non-smokers.
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TRUE!
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Aphthous Minor or Aphthous Major: Duration 3-7 days
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Minor
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Aphthous Minor or Aphthous Major: Most common for of aphthous
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Minor
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Aphthous Minor or Aphthous Major: 3 to 10 mm in diameter
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Minor
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Aphthous Minor or Aphthous Major: May be up to several cm in diameter
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Major
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Aphthous Minor or Aphthous Major: May have genital lesions
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Major
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Apthous Minor or Aphthous Major: Etiology includes primary immunodysregulation, decrease of mucosal barrier, increase of antigenic exposure.
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BOTH
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Aphthous Minor or Aphthous Major: Mucobuccal fold most common site, also tongue, palate, labial mucosa and gingiva
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BOTH
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Trauma, endocrine conditions, psychic factors and allergic factors may precipitate this condition
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Aphthous Minor and Major
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Condition characterized by as many as 100 lesions averaging 1-3 mm in diameter.
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Herpetiform Aphthous
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This condition clinically resembles primary herpes.
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Herpetiform Aphthous
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Should you treat a patient with topical steroids if they present with primary herpes-like lesions?
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Only if they've had multiple recurrence
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What is the age and gender predilection for herpetiform aphthous?
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Young adult, Female
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Besides respiratory viral infections, what is the most common viral infection?
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Herpes Simplex
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Which HSV type affects predominantly face, lips and oral cavity?
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HSV Type I
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Which HSV type affects predominantly genitals and skin of lower body?
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HSV Type II
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HSV resides in cells of which origin?
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Ectodermal
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Primary HSV infection usually occurs at age?
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Child, 1-10 y.o.
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What percent of infections have clinical dz?
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1-10%
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What percent of the population display antibodies?
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50-90%
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How is HSV transmitted?
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Direct contact with saliva or droplet carrying virus
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Primary Herpetic Gingivostomatitis may be characterized by what 4 clinical features?
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1 2-4 mm vesicles and ulcers 2 Bleeding/Painful ginigiva (early sign) 3 Painful, ragged ulcers 4 Pharyngotonsilitis (primary infection in adults)
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How long do primary herpetic lesions last?
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7-14 days
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"Ballooning degeneration" and Lipshutz bodies (intranuclear inclusions) are characteristics of which infection?
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Primary Herpetic Gingivostomatitis
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What are 3 other synonyms for Recurrent Herpes Simplex?
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1 Herpes Labialis 2 Fever Blister 3 Cold Sore
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Which HSV infection usually occurs on the muco-cutaneous junction?
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Recurrent Herpes Simplex
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What is the usual progression of a Recurrent Herpes Simplex lesion?
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1 Preceded by burning sensation 2 Swelling 3 Vesicle formation 4 Ulceration
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How long does a Recurrent Herpes Simplex lesion last?
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4-10 days
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Where do Recurrent Intraoral Herpes Simplex lesions occur?
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Mucosa bound to periosteum (hard palate and gingiva)
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Which HSV lesion consists of multiple small painful ulcers, often are precipitated by dental Tx, and last 7-10 days?
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Recurrent Intraoral Herpes Simplex
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Name the virus that causes chickenpox.
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Varicella-zoster virus
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What is the probable entry point for the varicella-zoster virus?
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Respiratory
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What dz is characterized by maculopapular or vesicular eruptions on skin, seen in ages 5-9 usually, appear on trunk and face and then extremities and may leave scars?
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Chickenpox
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What are the 4 stages of chickenpox lesions?
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1 Erythema 2 Vesicle 3 Pustule 4 Hardened crust
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T/F: Chickenpox lesions are painless.
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TRUE (diff. from HSV which are painful)
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Which virus causes herpes zoster (shingles)?
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Varicella-zoster virus
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Which dz is characterized by very painful lesions, inflammation of dorsal root ganglia and is the recurrent form of chickenpox?
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Herpes Zoster
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Which dz is characterized by fever, pain and tenderness along nerve, migraine headache?
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Herpes Zoster
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Is herpes zoster displayed unilaterally or bilaterally?
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Unilaterally
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Which virus causes infectious mononucleosis?
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Epstein-Barr virus
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How is the Epstein-Barr virus transmitted?
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Intimate contact, usually contaminated saliva
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Lymphadenopathy, pharyngitis, hepatosplenomegaly, rhinitis, cough, etc. are characteristic of what dz?
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Infectious Mono
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What are 2 possible oral manifestions of infectious mono?
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1 Petechiae on hard/soft palate 2 Possible ANUG
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Which virus causes Herpangina (aphthous pharyngitis)?
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Coxsackie group A, types 1-6, 10, 16, 22
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What time of year and in what age group does herpangina occur?
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Usually summer, children
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Which virus causes Hand, Foot and Mouth Dz?
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Coxsackie group A16
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What is the age predilection for Hand, Foot and Mouth Dz?
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Young children (5 mos to 5 yrs)
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What dz is characterized by maculopapular, exanthematous and vesicular lesions of the skin (esp. hands, feet, legs and mouth)?
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You better get this one!
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What do the intraoral lesions look like in Hand, Foot and Mouth Dz?
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Small, multiple vesicular lesions on hard palate, tongue and buccal mucosa
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What dz is characterized by fever, malaise, conjuntivitis, photophobia and eruptive lesions on the skin and oral mucosa (rash)?
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Measles (rubeola)
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These spots occur on the buccal mucosa 2-3 days before skin rash and appear as bluish-white specks surrounded by a white margin.
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Koplik's spots
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What area of the body do measles rash first occur?
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Face
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Which mild viral illness is caused by togavirus?
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Rubella (German measles)
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Which dz can cause fetal deaths or Congenital Rubella Syndrome?
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Rubella (German measles)
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In Rubella, what do you call the small, discrete, dark-red papules that develop on the soft palate and arise about 6 hours after the first symptoms, but do not last longer than 12-14 hours?
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Forchheimer's sign
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What is the classic triad of Congenital Rubella Syndrome?
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1 Deafness (80%) 2 Heart Dz 3 Cataracts
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Which HPV types cause Condyloma Acuminatum?
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HPV 6,11,16,18
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Which dz appears clinically as solitary or multiple pinkish, sessile papules with pebbled surface?
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Condyloma Acuminatum
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Condyloma Acuminatum makes up about __% of all STDs.
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20%
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What fungal infection is a yeast-like infection caused by a common inhabitant of the oral cavity?
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Candidiasis
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This incection affects the young, debilitated persons, patients w/ chronic dz and diabetics, and is seen in overuse of antibiotics.
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Candidiasis
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Describe the clinical appearance of candidiasis.
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Milk curds, white elevated plaque consist of fungal hyphae, bleed when wiped off
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What is it called when the corners of the mouth are involved in a candida infection?
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Angular cheilitis (Perleche)
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Name the six types of candidiasis.
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1 Pseudomembranous candidiasis 2 Erythematous Candidiasis 3 Median Rhomboid Glossitis 4 Angular Cheilitis 5 Chronic Hyperplastic Candidiasis 6 Mucocutaneous Candidiasis
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What is the most recognized form of candidiasis, often assoc. with antibiotics, steroid use and immunosuppression?
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Pseudomembranous Candidiasis
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Where does Pseudomembranous candidiasis occur orally?
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Buccal mucosa, hard palate, dorsal tongue
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This form of candidiasis has red macules w/ burning sensation, often found in patients wearing dentures, after antibiotic therapy, and may have loss of filiform papillae.
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Erythematous Candidiasis (Denture stomatitis)
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Which type of candidiasis looks like geographic tongue and is asymptomatic?
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Median Rhomboid Glossitis
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Which type of candidiasis is associated with decreased VDO, has red fissured area at the corner of the mouth and is generally seen in older persons?
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Angular cheilitis (Perleche)
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This is the least common type of candidiasis. It has a white patch that cannot be removed (looks like leukoplakia) and occurs on the anterior buccal mucosa.
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Chronic Hyperplastic Candidiasis
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This form of candidiasis is seen in some patients with immunologic disorders and occurs on mucous membranes, skin, and nails. It has thick white plaques that don't wipe off.
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Mucocutaneous Candidiasis
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Name the disease that histologically features hyphae, viewable with 20% potassium hydroxide or PAS stain.
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Candidasis
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Name the most commonly used topical/systemic agent used to treat Candidiasis.
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Nystatin
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Name the disease acquired by inhalation of spores from bird excrete.
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Histoplasmosis
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Name the two common areas of the US to find Histoplasmosis infection.
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1 Mississippi Valley 2 Northeastern US
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What three clinical manifestations do Histoplasmosis and Infectious Mono have in common?
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1 Splenomegaly 2 Hepatomegaly 3 Lymphadenopathy
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What system does Histoplasmosis have a predilection to infect?
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Reticulo-endothelial
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What do oral lesions from Histoplasmosis look like?
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Nodular/ulcerations on buccal mucosa, gingiva, tongue, palate, and lips
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What fungus produces tuberculosis-like symptoms?
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Blastomycosis
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What do oral lesions from Blastomycosis look like? What two other diseases do they resemble?
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Ulcerations of the tongue with irregular, rolled borders. Actinomycosis or Squamous Cell carcinoma
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Why do you have to biopsy blastomycosis?
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It has pseudoepithiomatous hyperplasia! (Just like granular cell tumor)
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What fungus causes Valley Fever?
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Coccidiomycosis
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Name the area of the US where it is likely to find Coccidiomycosis.
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Southwestern US
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Name the two forms of coccidiomycosis infection.
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1 Primary, non disseminated 2 Disseminated
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Name the one clinical manifestation of primary coccidiomycosis infection. What two other skin diseases can be triggered?
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Cough. 1 Erythema nodosum or 2 Multiforme
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What is special about secondary coccidiomycosis infection?
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It is bad, and 50% are fatal
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Name the two bacteria that cause impetigo.
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1 Strep pyogenes 2 Staph aureus
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What disease causes fragile vesicles or long-lasting bullous lesions that are amber-colored?
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Impetigo
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What is the age predilection for impetigo?
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Young children
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What is the age predilection for scarlet fever?
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Children
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Name 3 oral manifestations of scarlet fever.
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1 "stomatitis scarlatina" 2 Strawberry tongue (white), followed by 3 Raspberry tongue (red)
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Name the specific bacteria that causes scarlet fever.
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Group A Beta-hemolytic strep
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Name the bacteria that causes syphilis.
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Treponema pallidum
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What two stages of syphilis are highly infectious?
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Primary, secondary
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Name the primary lesion fo syphilis.
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Chancre
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Name the three lesions of secondary syphilis.
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1 Maculopapular rash 2 Mucous patches 3 Condylomata lata
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During which syphilis stage might you have mild fever, hoarseness, dysphasia, inflamed tonsils, redness of soft palate (NOT hard)?
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Secondary
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Name the tertiary lesion for syphilis.
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Gumma (painless, necrotic granuloma)
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During which syphilis stage might you haveCNS, skin, CVS, skeleton, joint involvement?
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Tertiary
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During which syphilis stage might you see syphilitic glossitis in males, and perforation of the palate?
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Tertiary
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After which month of gestation can congenital syphilis be transmitted through the placenta?
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4th month
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Name the two types of congenital syphilis.
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1 Generalized 2 Late congenital
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Name the pathognomonic sign for generalized congenital syphilis.
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Rhagades (cracking and healing with scars)
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Name two other clinical manifestations of generalized congenital syphilis, besides the pathognomonic sign.
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1 Snuffles (rhinitis) 2 Saddle nose (necrosis of nasal septum)
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Name the three components of Late congenital syphilis' pathognomonic Hutchinson's triad.
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1 Hutchinson's teeth (screwdriver incisors and mulberry molars) 2 Ocular interstitial keratitis 3 8th nerve deafness
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How could gonococcal stomatitis affect the oral cavity (this is rare)?
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Fellatio, etc.
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Name 3 other diseases that gonococcal stomatitis may resemble.
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1 Erythema multiforme 2 Erosive lichen planus 3 herpetic stomatitis
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Name a disease that is a rapidly progressive infection by opportunistic bacteria, in immunocompromomised patients.
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Noma
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Name the periodontal disease that noma may begin as.
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ANUG
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Name the anaerobic, gram +, non acid-fast, filamentous bacteria that usually lives in the oral flora but can cause infections in wounds.
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Actinomycosis
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What disease is associated with "Sulfur granules"? What are sulfur granules?
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Actinomycosis. Large yellowish clumps of bacteria that are in pus from abcesses
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Name the disease that can cause lymphadenitis in children and is self-limiting.
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Cat Scratch
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Oral Manifestions of HIV and AIDS
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Prior to HAART, this condition was often first seen in the late asymptomatic stage of HIV infection.
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Hairy Leukoplakia
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What is the etiology of hairy leukoplakia?
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Epstein-Barr virus (seen only in immunocompromised host)
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What are 4 clinical features that characterized hairy leukoplakia?
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1 Usually bilateral 2 Rough, shaggy, dense leukoplakia that won't wipe off 3 Irregular borders w/ vertical extensions 4 Corduroy-like surface
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What condition is usually bilateral and almost invariably involves the lateral borders of the tongue?
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Hairy Leukoplakia
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What are 4 histologic features of hairy leukoplakia?
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1 Hyperparakeratosis 2 Acanthosis 3 Balloning of spinous cells 4 Minimal inflammation in supporting C.T. (good for Dx!)
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List 6 predisposing factors for Simple Oral Candidiasis.
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1 Immature immune system 2 Antibiotic therapy 3 Dentures (or retainers!) 4 Smoking 5 Poor OH 6 Debilitating systemic dz (usually in the elderly)
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T/F: A person who gets Candidiasis for the first time should be considered to have HIV infection.
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False-this is a very common oral infection in the general population.
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Candidiasis in what specific region should be considered highly suspicious for being HIV-related?
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Oropharynx
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Erythema, white "curds" which wipe off leaving raw/bleeding surface, and white plaque-like areas that do not wipe off are clinical features of what oral infection?
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Candidiasis
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What are 2 histologic features of candidiasis?
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1 Budding yeasts and pseudohyphae invading into superficial epith 2 Inflammation (primarily acute)
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What malignant neoplasm derived from endothelial cells may be the first presentin sign of AIDS?
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Kaposi Sarcoma
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What are 2 etiological factors that may cause K.S.?
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1 Infection by HSV-8 2 Immunocompromised host
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Kaposi sarcoma is multicentric. What are the 4 primary areas that may be involved?
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1 Skin 2 Mucous membrane 3 Lungs 4 GI tract
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What is the single most common oral site for K.S.?
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Palate (Ant. Max. gingiva is second)
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What oral dz has well-circumscribed, red to purple, often flat lesions (early) or elevated (advanced) with no surface ulcerations expected?
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Kaposi Sarcoma
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What is the Dx technique used to establish a definitive Dx?
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Biopsy
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Name 2 HIV-associated Perio diseases.
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1 Linear Gingival Erythema 2 Necrotizing Ulcerative Periodontitis
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What perio dz has markedly reddened gingiva, out of proportion to plaque levels?
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Linear Gingival Erythema
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What perio dz may be focal or generalized, may or may not have color changes, pronounced attachment loss, possible spontaneous exfoliation of teeth, necrosis, sloughing of bone and/or soft tissue and spontaneous bleeding ulcerations? (is that enough hints for you?!!)
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Necrotizing Ulcerative Periodontitis
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Name 3 Herpes family viruses that may have more frequent reactivation in HIV-AIDS patients.
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1 HSV 2 Herpes zoster 3 Cytomegalovirus (usually retinitis, oral is rare)
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What is the most common deep (invasive) fungal infection in the AIDS population?
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Histoplasmosis
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T/F: Non-Hodgkin Lymphoma is common in AIDS patients.
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TRUE (and oral lesions are common)
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What is the prognosis for and HIV+ person with non-Hodgkin Lymphoma?
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POOR
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Oral Manifestations of Skin Disease
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Name the term used for a group of inherited conditions in which two or more - of hair, sweat glands, teeth, and nails fail to develop
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Ectodermal Dysplasia
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What are three oral manifestations of ectodermal dysplasia?
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1 Hypodontia 2 Abnormal-shaped teeth 3 Tapered anterior crowns
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What is the mode of transmission for white sponge nevus?
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Autosomal dominant
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When does white sponge nevus appear?
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Birth or childhood
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Where is the most common site for white sponge nevus?
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Buccal mucosa
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Name the disease that histologically features hyperparakeratosis and acanthosis.
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White Sponge nevus
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Name 3 skin diseases with oral manifestations that are discussed in other sections of oral path.
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1 White sponge nevus 2 Peutz-Jegher 3 Hereditary Hemorrhagic Telangiectasia
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Name the most common skin disease with oral manifestations.
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Lichen Planus
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What is the etiology of lichen planus?
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T-cell mediated autoimmune process
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What liver disease is often associated with lichen planus in Mediterranean countries?
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Hepatitis C
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What is the age and gender predilection for lichen planus?
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Middle age women
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What are the four skin symptoms (4 P's) of lichen planus?
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1 Purple 2 Pruritic 3 Polygonal 4 Papules
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What are the 3 most common places on the skin for lichen planus to be found?
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1 Flexor surfaces of wrists 2 Inner surface of knees 3 Inner surface of thighs
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What is the most common location for lichen planus of the oral cavity?
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Buccal mucosa.
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What are the four types of lichen planus?
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1 Reticular 2 Plaque form 3 Atrophic 4 Erosive
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What is the most common type of lichen planus?
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Reticular
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Reticular or Erosive Lichen Planus: Have striae of Wickham
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Reticular
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Reticular or Erosive Lichen Planus: Asymptomatic
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Reticular
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Reticular or Erosive Lichen Planus: Usually bilateral buccal mucosa
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Reticular
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Reticular or Erosive Lichen Planus: Painful
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Erosive
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Reticular or Erosive Lichen Planus: Striae around an ulcer
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Erosive
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Reticular or Erosive Lichen Planus: Might look like squamous cell carcinoma, pemphigus, or pemphigoid
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Erosive
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Reticular or Erosive Lichen Planus: Desquamative gingivitis
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Erosive
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Which disease histologically features hyperkeratosis, saw-tooth rete ridges, basilar cell destruction, lymphocytes lined up at basement membrane, and eosinophilic coagulum?
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Lichen Planus
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What is the etiology of the Pemphigus family?
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Autoantibodies to desmosomes, causing spinous layer to fall apart
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What is the most common type of Pemphigus?
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Pemphigus vulgaris, because vulgaris means common
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What is the age and ethnic predilection for Pemphigus?
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Adults around 50, and Jew.
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Pemphigus starts out as a rapid ______, which ruptures to leave behind __________.
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Bullae/vesicle, ulcerations
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What skin area is most often affected by Pemphigus?
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Torso
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Which two diseases are positive for Nikolsky's Sign?
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1 Pemphigus family 2 BMMP
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Which usually presents first for Pemphigus family, oral or skin conditions?
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Oral
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Which disease histologically features acanthoLYSIS, Tzanck cells, suprabasilar vesicles, and "rows of tombstones"?
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Pemphigus
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What is the best to confirm diagnosis of Pemphigus?
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DIRECT immunofluorescence, though indirect can be used
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What is the full name for BMMP, and what is a synonym for BMMP?
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Benign Mucous Membrane Pemphigoid. Cicatricial Pemphigoid
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What is the etiology of BMMP?
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Antibodies to the basement membrane
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What is the age and gender predilection for BMMP?
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Older age (50-60), females
|
|
Which blisters last longer, pemphigus or BMMP?
|
BMMP
|
|
What are the three locations for BMMP?
|
1 Oral mucosa 2 Eyes 3 Genitalia
|
|
Which disease histologically features subepidermal vesicles, hemidesmosomes involved, no acantholysis and Tzank cells?
|
BMMP
|
|
Name the 3 diseases that may present with desquamative gingivitis.
|
1 Pemphigus family 2 BMMP 3 Erosive Lichen planus
|
|
What is the age predilection for bullous pemphigoid?
|
Older age (60)
|
|
What is the etiology of erythema multiforme?
|
Unknown (HA). But, maybe hypersensitivity to a… something (viral lesions? GI conditions? Radiation therapy?).
|
|
What is the age and gender predilection for erythema multiforme?
|
Young adults, male
|
|
What is the classic skin lesion of erythema multiforme?
|
Target lesion
|
|
What is the oral presentation of erythema multiforme?
|
Bloody, crusty, ulcerative, painful macules/papules
|
|
Name the two syndromes associated with erythema multiforme.
|
1 Stevens Johnson 2 TEN - Toxic Epidermal Necrosis
|
|
Name the four body parts affected by Stevens Johnson.
|
1 Skin (less than 10%) 2 Oral cavity 3 Eyes 4 Genital urethritis (GROSS!)
|
|
What percent of the body or more must be affected by erythema multiforme to be called Toxic Epidermal Necrosis?
|
30%
|
|
What are the three types of Lupus Erythematosus?
|
1 Systemic lupus erythematosus 2 Chronic cutaneous lupus 3 Subacute cutaneous lupus
|
|
What is the age and gender predilection for Systemic LE?
|
Middle age (30-40) WIMMEN
|
|
Name four clinical features of Systemic LE.
|
1 Butterfly rash 2 Kidney failure 3 Libman-Sacks warty vegetations on heart 4 Oral lesions
|
|
Which type of Lupus Erythematosus has few or no symptoms?
|
Chronic cutaneous lupus
|
|
T/F: Chronic cutaneous LE is on sun-exposed skin.
|
TRUE
|
|
T/F: Chronic cutaneous LE has butterfly rash.
|
TRUE
|
|
What skin disease manifests in the oral cavity as white/red plaques and possible ulcerations, which are uncommon?
|
Psoriasis
|
|
What disease features scaly papules on most of the skin?
|
Psoriasis
|
|
What is the age predilection for psoriasis?
|
Children/Young adult (10-30)
|
|
What skin disease can resemble geographic tongue?
|
Psoriasis
|
|
How do you get Epidermolysis Bullosa?
|
Inherited
|
|
Name the disease that has blistering mucocutaneous problems.
|
Epidermolysis Bullosa
|
|
What are the four basic types of Epidermolysis Bullosa?
|
1 Simplex 2 Junctional 3 Dystrophic 4 Acquisitia
|
|
Which type of Epidermolysis Bullosa will have a blister anywhere you put pressure?
|
Simplex
|
|
Which three types of Epidermolysis bullosa are inherited?
|
1 Simplex 2 Junctional 3 Dystrophic
|
|
Which type of Epidermolysis Bullosa is autoimmune?
|
Acquisitia
|
|
Which two types of Epidermolysis bullosa features blisters at birth?
|
1 Junctional 2 Dystrophic
|
|
Which disease may cause fingernails to be lost?
|
Epidermolysis Bullosa
|
|
Name 4 oral manifestations of Epidermolysis bullosa.
|
1 Gingival erythema 2 Anodontia 3 Enamel hypoplasia 4 Bulla/vesicle formation
|
|
Name the disease that is caused by excess collagen deposition.
|
Scleroderma
|
|
What is the age and gender predilection for scleroderma?
|
Middle age (30-50), female
|
|
What skin disease features widened PDL and condylar resorption?
|
Scleroderma
|
|
Besides oral conditions, what are 3 clinical manifestations of scleroderma?
|
1 Organ failure 2 Raynaud's phenomenon 3 Neuralgia/paresthesia
|
|
What is the term used for localized scleroderma?
|
Coup de saber, which involves a solitary patch of skin only
|
|
What is the age and gender predilection for Reiter's syndrome?
|
Young adults, MALE!
|
|
What is the etiology of Reiter's syndrome?
|
Immunologically mediated, after exposure to something like dysentery or VD
|
|
What is the classic triad of Reiter's syndrome?
|
1 Nongonococcal urethritis 2 Arthritis 3 Conjunctivitis
|
|
What do oral lesions of Reiter's syndrome look like?
|
Erythematous papuls and ulcerations
|
|
How do you get Darier's disease?
|
Inherited (Autosomal dominant)
|
|
What is the age predilection for Darier's disease?`
|
Teens (10-20)
|
|
Name 4 extraoral clinical manifestations of Darier's disease.
|
1 Rough texture due to accumulated keratin 2 Foul odor 3 Pits/keratoses on palms/soles 4 Longitudinal lines and ridges on nails
|
|
What do oral lesions of Darier's disease look like?
|
White, flat papules, cobblestone in appearance
|
|
What is the solitary version of Darier's disease?
|
Warty Dyskeratoma
|
|
What is the age predilection for Warty Dyskeratoma?
|
Older than 40 (Warty forty)
|
|
Syndromes of Dental Interest
|
|
|
Name 13 diseases that are autosomal dominant
|
1 Crouzons 2 Aperts 3 Treacher Collins 4 Cleidocranial dysplasia 5 Marfan Syndrome 6 Pachyonychia Congenita 7 Gardner's 8 Peutz-Jeghers 9 Multiple Hereditary Hemorrhagic Telangiectasia 10 Basal Cell Nevus Syndrome 11 Hereditary Ectodermal Dysplasia 12 Von Recklinghausen's 13 Cowden Syndrome
|
|
Name the one syndrome that is autosomal recessive.
|
Papillion Lefevre Syndrome
|
|
What 5 features are common to both Crouzon's and Apert Syndrome?
|
1 Ocular proptosis (bug eyes) 2 Maybe "cloverleaf" skull 3 Hypertelorism (wide-spaced eyes) 4 Hypoplastic maxilla 5 Malocclusion
|
|
How is Crouzon Disease transmitted?
|
Autosomal dominant
|
|
What is the cause for the symptoms of Crouzon's Disease?
|
Premature closing of cranial sutures
|
|
Name two things that Crouzon has that Apert's does not.
|
1 Brachycephaly 2 Trigonocephaly
|
|
How is Apert Syndrome transmitted?
|
Autosomal dominant
|
|
Name 4 extraoral and 5 oral-related things that Apert has that Crouzon's does not.
|
1 Acrobrachycephaly 2 Down-slanting of lateral palpebral fissures 3 Mental retardation 4 Syndactyly. (Oral - 1 Mandibular prognathism 2 Cleft soft palate 3 Bifid uvula 4 Gingival thickening 5 Shovel shaped incisors
|
|
How is Treacher-Collins Syndrome transmitted?
|
Autosomal dominant
|
|
What disease features mandibular micrognathia, causing "bird-like appearance"?
|
Treacher-Collins Syndrome
|
|
What disease features zygomatic atrophy?
|
Treacher-Collins Syndrome
|
|
What disease features coloboma (notched lower eyelid) and downward slanting of lower eyelid?
|
Treacher-Collins Syndrome
|
|
What disease features external/internal ear defects?
|
Treacher-Collins Syndrome
|
|
What disease features disrupted collagen maturation leading to bone with thin cortex, fine trabeculation, and diffuse osteoporosis?
|
|
|
What disease features blue sclera and dentinogenesis imperfecta/opalescent dentin?
|
Osteogenesis Imperfecta
|
|
How is Cleidocranial Dysplasia transmitted?
|
Autosomal dominant OR spontaneous
|
|
What disease features absence or hyposplasia of clavicles?
|
Cleidocranial Dysplasia
|
|
What disease features brachycephaly, hypertelorism WITH frontal/occipital bossing?
|
Cleidocranial Dysplasia
|
|
What disease features a lack of secondary cementum?
|
Cleidocranial Dysplasia
|
|
What disease features tons of supernumerary teeth (42 in the mandible!)?
|
Cleidocranial Dysplasia
|
|
Name the triad of symptoms for Pierre Robin Syndrome.
|
1 Cleft palate (= cleft bird mouth) 2 Mandibular micrognathia (= tiny bird, peep peep) 3 Glossoptosis (= bird choking on tongue by begging for food)
|
|
How is Marfan Syndrome transmitted?
|
Autosomal dominant
|
|
What disease features abnormally soluble collagen?
|
Marfan Syndrome
|
|
What disease features tall, slender stature with large hands and fingers?
|
Marfan Syndrome
|
|
What disease features cardiovascular defects such as aortic dilation and mitral valve prolapse?
|
Marfan Syndrome
|
|
What disease features high arched palate, bifid uvula and malocclusion?
|
Marfan Syndrome
|
|
What disease features a small maxilla/mandible, and high arched palate, resulting in malocclusion?
|
Down's Syndrome
|
|
What disease features somewhat smaller than usual teeth, with short roots?
|
Down's Syndrome
|
|
What disease features macroglossia and fissured tongue?
|
Down's Syndrome
|
|
What disease features bone replacement by vascular tissue, then fibrous tissue?
|
Massive osteolysis
|
|
What disease features North Carolina and no treatment?
|
Hi BID - Hereditary Benign Intraepithelial Dyskeratosis
|
|
Name the 2 clinical manifestations of Hereditary Benign Intraepithelial Dyskeratosis.
|
1 White sponge nevus-like 2 Foamy, gelatinous eye plaques
|
|
How is Pachyonychia Congenita transmitted?
|
Autosomal dominant
|
|
What disease features loss of nails due to keratin accumulation?
|
Pachyonychia Congenita
|
|
What disease features oral lesions with thickened white plaques on lateral/dorsal tongue?
|
Pachyonychia Congenita
|
|
What disease features hyperkeratosis of hands and feet, plus hyperhydrosis?
|
Pachyonychia Congenita
|
|
How is Gardner's syndrome transmitted?
|
Autosomal dominant
|
|
What disease features colorectal polyps that may turn malignant (adenocarcinoma)?
|
Gardner's Syndrome
|
|
What disease features multiple osteomas?
|
Gardner's Syndrome
|
|
What disease features epidermoid cysts of the skin, coupled with increased thyroid carcinoma?
|
Gardner's Syndrome
|
|
What disease features slight increase in supernumerary/impacted teeth (this is NOT cleidocranial dysplasia)?
|
Gardner's Syndrome
|
|
How is Peutz-Jeghers Syndrome transmitted?
|
Autosomal Dominant
|
|
What disease features freckles and polyps leading to intrassusception, which may transform to adenocarcinoma?
|
Peutz-Jeghers Syndrome
|
|
How is Multiple Hereditary Hemorrhagic Telangiectasia transmitted?
|
Autosomal Dominant
|
|
What disease features epistaxis due to iron-deficiency anemia (nose bleeds)?
|
Multiple Hereditary Hemorrhagic Telangiectasia
|
|
What disease features vascular proliferation of tissues of the brain and face (port wine stain)?
|
Sturge-Weber
|
|
What disease features meningeal angiomatosis, convulsions, and mental retardation, along with calcifications in the brain?
|
Sturge-Weber
|
|
How is Basal Cell Nevus syndrome transmitted?
|
Autosomal Dominant
|
|
What disease features multiple odontogenic keratocysts?
|
Basal Cell Nevus Syndrome
|
|
What disease features multiple basal cell carcinomas of the skin?
|
Basal Cell Nevus Syndrome
|
|
What disease features rib anomalies, plus palmar/plantar pits?
|
Basal Cell Nevus Syndrome
|
|
What disease features mild hypertelorism and intracranial calcifications?
|
Basal Cell Nevus Syndrome
|
|
How is Cowden Syndrome transmitted?
|
Autosomal dominant
|
|
What disease features multiple small papules on the skin, gingiva, tongue, and buccal mucosa (not Peutz-Jehger)?
|
Cowden Syndrome
|
|
What disease features increased thyroid disease, such as goiter/adenoma?
|
Cowden Syndrome
|
|
What disease features increased breast cancer?
|
Cowden Syndrome
|
|
What disease features increased GI polyps?
|
Cowden Syndrome
|
|
What disease features hypermobility of joints, elastic skin, and abnormal collagen?
|
Ehlers-Danlos
|
|
What disease features papyraceous scarring?
|
Ehlers-Danlos
|
|
What disease features severe periodontal disease (tooth lost by 4 and 14 years old)?
|
Papillion-Lefevre
|
|
What disease features hyperkeratosis of hands and feet, in the first few years of life?
|
Papillion-Lefevre
|
|
Salivary Gland Diseases
|
|
|
What is the single-most common sign of salivary gland disease?
|
Swelling
|
|
What is the second-most common sign of salivary gland disease?
|
Pain
|
|
Pain and swelling may be signs of what three things, when it comes to salivary gland disease?
|
1 Infection 2 Obstruction 3 Neoplasia
|
|
Name 4 BASIC causes of xerostomia.
|
1 Problem at salivary center 2 Problem at autonomic pathway 3 Reduced salivary gland function from organic disease 4 Alterations in fluid/electrolyte balance
|
|
Name the two clinical terms used for swollen areas filled with mucus. When do you use which?
|
1 Mucocele 2 Ranula (floor of the mouth)
|
|
The majority of clinical mucoceles are…
|
Mucous escape reactions
|
|
What is the etiology of a Mucous Escape Reaction?
|
Mucous leaks into CT following a rupture in the duct system, and is seen as "non-self", so inflammation begins
|
|
What is the most common location for a mucous escape reaction?
|
Lower lip
|
|
Where is the most Uncommon location for a mucous escape reaction?
|
Upper lip, or hard palate
|
|
How do you differentiate a mucous escape reaction from an irritation fibroma?
|
Mucous escape reactions are more translucent, and have been present for days/weeks. Irritation fibromas have been there for months
|
|
What disease histologically features a cavity lined by granulation tissue/fibrous CT, filled with mucous, and with foamy histiocytes and neutrophils?
|
Mucous escape reaction
|
|
What is the etiology of a Mucous Retention cyst (Salivary duct cyst)?
|
Trauma to duct causes injured lining, closing off the duct and allowing for mucous to collect
|
|
What is the age predilection for Mucous retention cysts?
|
Adults around 50, and Jew.
|
|
How do you differentiate a mucous escape reaction from a mucous retention cyst?
|
Mucous escape reaction is caused by trauma; mucous retention cysts will not have a traumatic history
|
|
What disease histologically features a cavity lined by epithelium, without inflammation?
|
Mucous retention cyst
|
|
What disease is a stone in salivary duct or gland?
|
Sialolithiasis
|
|
What is the etiology for sialolithiasis?
|
Debris gets stuck in the duct, and normal calcium salt levels contribute to deposition and increase in size of stone
|
|
Name 3 predisposing factors to sialolithiasis.
|
1 Xerostomia 2 Infection 3 Foreign material
|
|
What disease is characterized by pain/swelling of the affected gland and increase in swellling at mealtimes?
|
Sialolithiasis
|
|
What is the most common place to find a sialolith? Why (3)?
|
Wharton's duct. 1 Long 2 Tortuous 3 Floor of the mouth
|
|
How do you differentiate between a sialolith and lymph node swelling?
|
Sialoliths change size throughout the day, lymph nodes do not
|
|
What disease is defined as inflammation of the salivary gland?
|
Sialadenitis
|
|
What is the most important/most common viral infection that causes sialadenitis?
|
Mumps
|
|
Name the most common bacterial infection that causes sialadenitis.
|
Strep species
|
|
Name two reasons why recent surgery may cause sialadenitis.
|
1 Low fluid intake 2 Anticholinergic drugs
|
|
Name 4 non-infectious causes of sialadenitis.
|
1 Sjogren's 2 Sarcoidosis 3 Radiation therapy 4 allergens
|
|
How do you differentiate between sialadenitis and sialolithiasis?
|
Sialadenitis will produce cloudy, thick, or purulent discharge when the gland is milked; stones will not produce any discharge
|
|
What disease histologically features neutrophils and exudate in the ducts/acini?
|
ACUTE sialadenitis
|
|
What disease histologically features patchy/diffuse infiltrates of lymphocytes and plasma cells?
|
CHRONIC sialadenitis
|
|
Name the inflammatory salivary gland disease that may be caused by dry, windy, sunny weather.
|
Cheiltis glandularis
|
|
Name the two clinical manifestations of cheilitis glandularis.
|
1 Eversion/swelling of the lip 2 Tiny red dots on the mucosa
|
|
What is the age and gender predilection for cheilitis glandularis?
|
Middle-aged men
|
|
What other disease may be seen with cheilitis glandularis (Jany's favorite)?
|
Actinic cheilitis
|
|
Name 4 more common causes of xerostomia.
|
1 MEDICATIONS 2 Aging 3 Smoking 4 Mouth breathing
|
|
Name 6 oral effects of xerostomia.
|
1 Shift to more cariogenic flora (like Candidasis, the single-most common opportunistic infection) 2 Increased risk of caries 3 Increased periodontal disease 4 Difficulty eating/swallowing 5 Atrophic glossitis (bald tongue) 6 Dried mucosa/mucosal atrophy
|
|
What is the best treatment for xerostomia? What other treatments are in the patient's best interest?
|
Eliminate underlying cause. Frequent checkups/caries prevention regime
|
|
What autoimmune disorder is characterized by uni/bilateral swelling of the parotid glands?
|
Benign Lymphoepithelial Lesion
|
|
Is Benign Lymphoepithelial lesion painful?
|
No, painless usually
|
|
What disease histologically features proliferation of lymphocytes (and looks like a lymph node), with atrophic/fibrosis of acini?
|
Benign Lymphoepithelial Lesion
|
|
Name the three clinical features of Primary Sjogren's syndrome. Name the three clinical features of Secondary Sjogrens.
|
Both have 1 Xeropthalmia 2 Xerostomia. Primary has Serologic evidence of autoimmune disease (rheumatoid, antinuclear antibodies, or anti-SS-A/B, Sjogren specific antibodies). Secondary has clinical features diagnostic for rheumatoid arthritis, SLE, polymyositis, scleroderma, or biliary cirrhosis.
|
|
What is the age and gender predilection for Sjogren's syndrome?
|
Middle-aged WOMEN (80-90%)
|
|
Where can you biopsy to diagnose for Sjogren's syndrome?
|
Minor glands of the lip, since they reflect the state of major glands (parotid is too hard to get to)
|
|
Which salivary gland disease requires a multidisciplinary approach?
|
Sjogren's syndrome
|
|
What disease is a very uncommon, non-inflammatory condition with asymptomatic salivary gland enlargement, most often in the parotids, caused by hormonal disorders/drugs/alcohol?
|
Sialadenosis (Sialosis)
|
|
Name the disease that is spontaneous necrosis of acini.
|
Necrotizing Sialometaplasia
|
|
Where is the most common site for necrotizing sialometaplasia?
|
Palate
|
|
What disease histologically features necrosis of minor glands, plus metaplasia of salivary ducts, with pseudoepitheliomatous hyperplasia?
|
Necrotizing Sialometaplasia
|
|
What is the etiology of Necrotizing Sialometaplasia?
|
Local ischemia
|
|
Why should a biopsy be done for something that looks like necrotizing sialometaplasia?
|
To rule out malignancy
|
|
What is the most common, most important salivary gland tumor?
|
Benign Mixed Tumor
|
|
What is the age predilection for Benign Mixed Tumor?
|
Adults 30-50
|
|
What is the most common site for Benign mixed tumor? What about minor salivary gland site?
|
Parotid. Palate (usually centered between midline and gingiva)
|
|
Name the disease that is a lumpy, slow-growing, painless swelling.
|
Benign Mixed Tumor
|
|
Why is a Benign mixed tumor so lumpy?
|
NO encapsulation!
|
|
What disease histologically features inner lining cells/outer myoepithelial cells, intermingled with mucoid/myxoid/chondroid tissue?
|
Benign Mixed Tumor
|
|
Name the benign tumor with epithelial cystic structures surrounded by a lymphoid stroma.
|
Warthin's Tumor
|
|
Where is the most common location for a Warthin's tumor? Are Warthin's usually (uni/bilateral)?
|
Parotid. Bilateral
|
|
What is the age and gender predilection for Warthin's tumor?
|
Older MEN (5x more common in men)
|
|
What disease histologically features inner layer of eosinophilic epithelial cells/outer layer of polygonal epithelial cells, benign lymphoid tissue/germinal centers, and a capsule?
|
Warthin's Tumor
|
|
If Richards shows a picture of a swelling on the upper lip, what should you write?
|
Canalicular Adenoma
|
|
What is distinctly unusual about the age predilection for canalicular adenomas?
|
They are more common in the 60+ group, which benign tumors RARELY are. Most tumors over 60 years old are malignant!
|
|
What disease histologically features strands of epithelial cells arranged in double rows?
|
Canalicular Adenoma
|
|
What is the most common malignant salivary gland tumor overall (and most common for parotid and minor glands)?
|
Mucoepidermoid carcinoma
|
|
What is unique about the behavior of mucoepidermoid carcinomas?
|
They vary GREATLY in their behavior, from benign to very very aggressive
|
|
What is 'oddball' about the age predilection for mucoepidermoid carcinomas?
|
It affects 20-40 years old, which is RARE for malignant tumors
|
|
What disease histologically features squamous cells, mucus-secreting cells, and infiltrating islands of epithelium?
|
Mucoepidermoid carcinoma
|
|
T/F: Mucoepidermoid carcinoma does NOT have a capsule.
|
TRUE
|
|
What ratio determines the behavior of mucoepidermoid carcinomas? Increase of which component is more likely to be bad?
|
Epidermoid: Mucus. More epidermoid = more likely to be bad
|
|
What very rare tumor resembles serous acinar cells, with no age predilection?
|
Acinic Cell Carcinoma
|
|
Which malignant salivary gland tumor is uniquely fixed (not fluctuant)?
|
Acinic Cell Carcinoma
|
|
What disease histologically features mass of epithelial cells that look like normal acinar cells, with clear cytoplasm?
|
Acinic Cell Carcinoma
|
|
What is the most common of the rare group of malignant mixed tumors?
|
Carcinoma-ex-mixed tumor, which is a benign tumor that turned malignant
|
|
What is the name for a true mixed tumor where the tumor is both epithelial and mesenchymal?
|
Carcinosarcoma
|
|
What is the single-most common malignant salivary gland tumor in the submandibular glands?
|
Adenoid Cystic Carcinoma
|
|
What is the age predilection for Adenoid cystic carcinoma?
|
Middle-age
|
|
Which disease histologically features cells forming cystic spaces (looks like colloid), with a typical "swiss cheese" pattern?
|
Adenoid Cystic Carcinoma
|
|
T/F: Adenoid Cystic Carcinoma does NOT have a capsule.
|
True, invades like crazy
|
|
What malignant tumor is notorious for invading along neurovascular bundles?
|
Adenoid Cystic Carcinoma
|
|
What disease will you live with for several years, but eventually die of because it is hard to cure and metastasizes?
|
Adenoid Cystic Carcinoma
|
|
What is the age predilection for polymorphous low-grade adenocarcinoma?
|
Middle-older age
|
|
What is the most common site for polymorphous low-grade adenocarcinoma?
|
Palate
|
|
Name the disease that histologically features bland, uniform cells, "indian filing" of cells, perineural invasion and some 'swiss cheese'.
|
Polymorphous low-grade adenocarcinoma
|