Oral Pathology

Front 1

clinical findings in primary herpetic gingivostomatitis?

Back 1

acute, hemorrhagic gingivitis (must be present for diagnosis), malaise, cervical adenopathy, vesicles and ulcers

Front 2

herpes labialis?

Back 2

cold sores, fever blisters: latent virus in trigeminal periodically reactivated by colds and fevers, sun, trauma, stress, menstrual periods

Front 3

why is herpes labialis contained?

Back 3

prior antibodies

Front 4

lifecycle of herpes labialis vesicles?

Back 4

break, ulcer, crust, and heal in 2 weeks

Front 5

secondary intraoral herpes?

Back 5

delicate vesicles/ulcers on gingiva/hard palate induced by trigger (NOT sunlight)

Front 6

how make diagnosis of HSV1?

Back 6

tzanck smear of vesicular fluid shows acantholytic cells with viral inclusions (lipschutz bodies) and multinuclear cells

Front 7

lipschutz bodies?

Back 7

viral inclusions seen with HSV1

Front 8

how does hand, foot, mouth disease differ from primary herpes?

Back 8

caused by coxsackie virus, lacks gingivitis, has digital lesions

Front 9

herpangina?

Back 9

coxsackie virus, small vesicles and ulcers limited to soft palate and pharynx

Front 10

characteristic presentation of zoster?

Back 10

unilateral without crossing the midline

Front 11

what indicates ocular involvement in an outbreak of zoster?

Back 11

involvement of tip of the nose

Front 12

ANUG?

Back 12

acute necrotizing ulcerative gingivitis caused by fusospirochetal anaerobes

Front 13

clinical presentation of ANUG?

Back 13

punched out necrotic ulcers of gingival papillae with foul odor

Front 14

how is ANUG differentiated from primary herpes?

Back 14

necrosis of papillae, absence of other oral vesicles or ulcers (localized to gingiva), not expected in children

Front 15

stevens-johnson sx?

Back 15

erythema muliforme affecting mouth, eyes, skin and genital mucosa; skin lesions are red macules, papules, blisters and target lesions of palms and soles

Front 16

pathogenesis of stevens-johnson sx?

Back 16

cytotoxic t cell mediated, type IV delayed hypersensitivity reaction to recent herpes outbreak, URI, meds, lymphoma

Front 17

recurrent aphthous ulcers aka?

Back 17

stomach ulcers, canker sores

Front 18

how differentiated stevens-johnson sx from primary herpes?

Back 18

spares gingiva, confluent slough, skin and other mucosal lesions

Front 19

what population is unaffected by aphthous ulcers?

Back 19

smokers

Front 20

how are aphthous ulcers similar to and different from secondary herpes?

Back 20

similar: small, painful recurrent ulcers that heal in 7-10 days;
different: exclusively labile mucosa, never form vesicles

Front 21

lichen planus?

Back 21

mucocutaneous immune-mediated disease where t cell responds to basal cells

Front 22

clinical findings in lichen planus?

Back 22

chronic lesions that wax and wane; may burn; lacy white stria that do not rub off

Front 23

geographic tongue aka?

Back 23

benign migratory glossitis

Front 24

clinical findings in geographic tongue?

Back 24

red, depapillated blotches surrounded by elevated, yellow-white c-shaped border migrating over a period of a few weeks, then remitting

Front 25

clinical findings in candida?

Back 25

white plaques which scrape off leaving raw, red mucosa

Front 26

how diagnose candida?

Back 26

cytologic smear stained with PAS; KOH prep

Front 27

why is scraping performed with all red and white lesions?

Back 27

treatment for lichen planus with steroids gives candida opportunity for overgrowth so good to know if candida is existing concomitantly

Front 28

candida is opportunistic secondary to what?

Back 28

antibiotics, steroids, diabetes, HIV, antineoplastic therapy, xerostomia, irritating dentures, etc

Front 29

snuff patch?

Back 29

white, fissured lesion in area where smokeless tobacco is hled

Front 30

malignant potential with snuff patch?

Back 30

rarely dysplastic or premalignant, particularly if goes away with quitting or changing location

Front 31

nicotine stomatits?

Back 31

diffuse white lesion across hard paplate studded with raised bumps having red centers

Front 32

what causes nicotine stomatitis?

Back 32

heat of pipe smoke

Front 33

malignant potential of nicotine stomatitis?

Back 33

not premalignant; shows hyperkeratosis not dysplasia

Front 34

favored locations of dysplasia/carcinoma in situ?

Back 34

lower lip skin and vermillion, lateral tongue, ventral tongue, floor of mouth, soft palate, fauces, tonsillar tissue

Front 35

rule of thumb with non-descript white, red, or speckled mucosal patch?

Back 35

if present for more than 2 weeks without obvious cause or attribution to some specific disease and in high risk location for oral cancer should get it biopsied

Front 36

risk factors for oral cancer?

Back 36

HPV, UV exposure for lip cancer, 70% assoc with smoking with alcohol as cofactor

Front 37

how does oral cancer kill?

Back 37

local extension and neck metastasis rather than distant mets; painless until advanced

Front 38

most important prognostic factor in oral cancers?

Back 38

stage

Front 39

what oral lesions offer clues to undiagnosed HIV infection?

Back 39

candidiasis and hairy leukoplakia

Front 40

what virus is involved with hairy leukoplakia?

Back 40

EBV

Front 41

most frequent site of salivary gland neoplasms and shows the greatest variety of histologic types?

Back 41

parotid

Front 42

neoplastic cells in salivary gland neoplasm?

Back 42

myoepithelial and intercalated cells

Front 43

typical presentation of salivary gland neoplasm?

Back 43

painless, slow growing, submucosa, firm lump that is freely movable

Front 44

appearance of malignant vs benign salivary gland tumors?

Back 44

malignant: slow growing and may appear encapsulated, well-demarcated and histologicall well-differentiated with no hyperchromatis, pleomorphism, or mitotic activity;
benign: may show infiltrativeness and pleomorphism

Front 45

treatment for salivary gland tumors?

Back 45

removal of entire gland, any remaining could leak or recur

Front 46

most common salivary gland neoplasm?

Back 46

benign mixed tumor

Front 47

why is benign mixed tumor a misnomer?

Back 47

only 1 germ layer

Front 48

why is benign mixed tumor easy to misdiagnose on frozen sections or needle biopsy?

Back 48

variable histology that may show ducts, cysts, sheets of basaloid, squamoid, or spindle cells, hyaline, mucin and myxoid areas, chondroid, bone

Front 49

why is it imperative to not just shell out a benign mixed tumor?

Back 49

tumor buds penetrate the capsule so there is a high recurrence if don't take wide surgical margins

Front 50

epidemiology of warthin's tumor?

Back 50

80% males, mostly cigarette smokers

Front 51

what gland does warthin tumor affect?

Back 51

parotid

Front 52

pathognomonic histology of warthins tumor?

Back 52

papillary fronds lined by double row of columnar oncocytic cells resting on a non-neoplastic resident lymphoid stroma with germinal centers with fronts projecting into a cystic space

Front 53

most common malignancy of submandibular gland?

Back 53

adenoid cystic carcinoma

Front 54

aka 'wolf in sheeps clothing' and why?

Back 54

adenoid cystic carcinoma; benign looking but devastatingly infiltrative, showing persistent recurrences and eventual blood-borne mets up til 20 years

Front 55

histology of adenoid cystic carcinoma?

Back 55

'swiss chees' pattern of monotonous basaloid cells compartmentalized into ovoid cylinders by hyalinized pink material; from ductal and myoepithelial cells

Front 56

characteristics of adenoid cystic carcinoma progression?

Back 56

extensive perineural and intraneural invasion - infiltrative tumor nests run along nerves for a great distance from main tumor mass; clinically causes early pain and, in parotid, facial nerve paralysis

Front 57

treatment for adenoid cystic carcinoma?

Back 57

wide excision including extension up nerve trunks, NO neck dissection as tumor doesn't go to nodes; with distant mets the tx is mostly palliative