Orp: Oral Manifestations Of Hiv Infection

Front 1

list the oral fungal infections associated w/ HIV

Back 1

candidiasis
histoplasmosis

Front 2

three forms of candidiasis

Back 2

pseudomembranous
atrophic
angular cheilitis

Front 3

candidiasis affects what percent of AIDS patients

Back 3

90%

Front 4

candidiasis is seen when CD4 count is below:

Back 4

200/cubic mm

Front 5

pseudomembranous candidiasis:

clinical features

Back 5

white cottage-cheese plaques

lesions may be wiped away --> erythematous base

Front 6

if pseudomembranous candidiasis lesions cannot be wiped away, what form do they represent?

Back 6

chronic hyperplastic

Front 7

atrophic candidiasis:

clinical features

Back 7

erythematous

most often on tongue and palate

Front 8

angular cheilits:

clinical features

Back 8

ulcerations at mouth angles

typical co-infection w/ staph or strep

Front 9

candidiasis:

histology

Back 9

hyphae and conidia

Front 10

candidiasis:

treatment

Back 10

mycelex (clotrimazole) troches
-nystatin solution

vytone cream

systemic anti-fungal tx if recurrent

Front 11

histoplasmosis:

clinical features

Back 11

painful, indurated ulcers

often on palate, gingiva, tongue

Front 12

histoplasmosis:

treatment

Back 12

systemic anti-fungal
fluconazole
ketaconazole
itraconazole
amphotericin B

Front 13

list the oral viral manifestations of HIV

Back 13

herpes simplex
varicella-zoster
epstein-barr
cytomegalovirus
HPV
poxviurs

Front 14

herpes simplex virus:

percent of HIV patients w/ HSV infected ulcers

seen w/ CD4 count less than

Back 14

8%

200/cubic mm

Front 15

when is HSV an indicator of progression from HIV to AIDS

Back 15

when present > 4 weeks

Front 16

HSV:

clinical features

Back 16

vesicles rupture --> irregular ulcerations

involve keratinized/non-keratinized surfaces

Front 17

HSV:

may mimic...

Back 17

aphtous ulcers

Front 18

HSV:

histology

Back 18

acantholysis

nuclear clearing

nuclear enlargement

chromatin clumping

molded nuclei (Tzanck cells)

Front 19

HSV:

treamtent

Back 19

systemic anti-viral

acyclovir
valacyclovir
famcyclovir

Front 20

varicella-zoster virus:

clinical features

Back 20

unilateral eruption of maculopapular vesicles and ulcers

present in one branch of trigeminal

Front 21

VZV:

histology

Back 21

similar to HSV

Front 22

VZV:

treatment

Back 22

acyclovir
valacyclovir
famcyclovir

Front 23

Epstein-Barr Virus:

associated with what cancers

Back 23

nasopharyngeal carcinoma

Burkitt lymphoma

(also assoc. w/ lymphomas and oral hairy leukoplakia)

Front 24

oral hairy leukoplakia:

seen in what percent of AIDS patients

when CD4 count is below

Back 24

25-33%

CD4 less than 300

Front 25

oral hairy leukoplakia:

clinical features

Back 25

vertical white striations on ventrolateral tongue

lesions don't wipe away

Front 26

oral hairy leukoplakia:

histology

Back 26

thickened parakeratin w/ surface corrugations

peripheral margination of chromatin (nuclear beading)

Front 27

oral hairy leukoplakia:

treatment

Back 27

none

Front 28

most common cause of blindness in HIV patients

Back 28

CMV (retinitis)

Front 29

most common life-threatening viral infection in HIV patients

Back 29

CMV

Front 30

percent of population infected with CMV

Back 30

80%

(symptoms only in immune compromised individuals)

Front 31

CMV:

clinical features

Back 31

painful, non-specific ulcers

often on palate and gingiva

size from mm to cm

Front 32

CMV:

histology

Back 32

vascular endothelial cells show swelling and intracytoplasmic/intranuclear inclusion bodies (owl eye's)

similar changes to salivary duct epithelium

Front 33

CMV:

treatment

Back 33

ganciclovir
foscarnet
cidofavir

Front 34

HPV:

clinical features

Back 34

papilloma, verruca, condyloma lesions on oral or genital mucosa

often on lip, gingiva, palate

soft, pink, cauliflower-like

Front 35

HPV:

treatment

Back 35

excision/cautery

(don't use laser)

recurrence common

Front 36

molluscum contagiosum:

clinical features

Back 36

pruritic papules

bearded area of face

rarely intra-oral

Front 37

molluscum contagiosum:

treatment

Back 37

self-limiting if immunocompetent

no tx in HIV patients

Front 38

list the oral bacterial infections associated with HIV

Back 38

HIV-associated gingivitis
HIV-associated periodontitis
necrotizing ulcerative stomatitis

Front 39

HIV-associated Gingivitis:

clinical features

Back 39

linear gingival erythema

spontaneous blistering

petechiae-like lesions

Front 40

HIV-associated gingivitis:

treatment

Back 40

good hygeine

frequent visits

Front 41

HIV-associated Periodontitis:

clinical features

Back 41

pain/spontaneous gingival bleeding

edema/intense erythema

necrosis of interdental papillae

rapid alveolar bone loss

Front 42

HIV-associated periodontitis:

treatment

Back 42

resistant to tx

Front 43

necrotizing ulcerative stomatitis:

clinical features

Back 43

extension of periodontal disease

painful tissue destruction / necrosis

Front 44

necrotizing ulcerative stomatitis:

treatment

Back 44

debridement / removal of necrotic tissue

antibiotics

Front 45

list the oral neoplasms associated with HIV

Back 45

kaposi sarcoma
non-hodgkin lymphoma

Front 46

most common tumor in AIDS patients

Back 46

kaposi sarcoma

Front 47

kaposi sarcoma is strongly associated with what virus?

Back 47

HHV-8

Front 48

kaposi sarcoma:

clinical features

Back 48

blue-red-purple macules

on palate, gingiva, tongue

possible ulceration/bleeding

Front 49

kaposi sarcoma:

histology

Back 49

spindle cell proliferation

slit-like vascular spaces

extravasated RBCs

hemosiderin deposits

Front 50

kaposi sarcoma:

treatment

Back 50

biopsy (rule out bacillary aniomatosis)

excision, laser removal, or local radiation

Front 51

second most common tumor in AIDS patients

Back 51

non-hodgkin lymphoma

Front 52

how much more common is non-hodgkin lymphoma in AIDS patients

Back 52

60-70x

Front 53

has incidence of non-hodgkin lymphoma decreased since HAART?

Back 53

no (unlike KS)

Front 54

non-hodgkin lymphoma:

clinical features (oral)

Back 54

painful, enlarging ulcers

often on palate, retro-molar pad, tonsillar pillars, tongue

Front 55

non-hodgkin lymphoma:

extra-oral sites

Back 55

CNS, bone marrow, liver, GI

Front 56

non-hodgkin lymphoma:

histology

Back 56

high-grade B-cell lymphoma

sheets of malignant lymphocytes

Front 57

non-hodgkin lymphoma:

treatment

median survival

Back 57

radiation and chemo

4-11 months

Front 58

major aphthous ulcers:

clinical features

Back 58

painful ulcers

clearly demarcated borders

usually >10mm

Front 59

major aphtous ulcers:

treatment

Back 59

biopsy to rule out infection

topical or systemic steroids

thalidomide if refractory

Front 60

lymphoepithelial cyst:

clinical features

Back 60

painless

bilateral

parotid gland enlargement

Front 61

lymphoepithelial cyst:

histology

Back 61

cystic structure

stratified squamous epi

dense lymphocyte infiltrate within wall of cyst

Front 62

lylmphoepithelial cyst:

treatment

Back 62

excision