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94 Cards in this Set

  • Front
  • Back
what should be the first step in all cases?
divide and conquer - determine whether disease is acute or chronic
what is the course of acute lesions (time in arising and healing)?
arise rapidly (1-2 days), normally heal in 10-14 days
how do chronic ulcerations tend to develop?
initally, with minimal involvement, and slowly enlarge - most have been present for months before patient presents
what information should be obtained before making a differential diagnosis (2)?
1) extraoral lesions; 2) listing of all medication (prescription and over the counter)
how common are these?
most common oral lesions encountered by health professional - approximately 20 percent of population has positive history - prevalence as high as 55% in populations under stress
what type of immune response is thought to be responsible for initiation of the ulceration?
cell-mediated immune response (early RAU similar to delayed hypersensitivity)
what is the prototypical and most common form of recurrent aphthous ulceration?
minoraphthous ulceration (MiRAU)
where do these arise?
on nonkeratinized movable mucosa
what do they look like?
they have yellow fibrinopurulent membranes, surrounded by erythematous halos
how large are they and what is the normal course?
2-10mm and usually heal without scarring within 10-14 days
how many occur at a time?
from one to one hundred
what conditions may be ruled out in severe or nonresponsive cases that can cause lesions clinically identical to RAU (list)?
blood dyscrasia, nutritional deficiencies (zinc, folate, B12, iron), Behcet's syndrome, Crohn's disease, Celiac sprue, AIDS, and every one of the other acute ulcerative conditions
what is herpangina, and what causes it?
a specific viral infection which can be caused by any one of a number of strains of Coxsackie virus
who does it normally occur in?
young children 9but can occur in older patients)
how does the immune system function against these viruses?
complete immunity to a strain develops, but an individual can have the disease several times from different strains
what will affected patients present with (5)?
1) sore throat; 2) fever (low-grade); 3) headache; 4) abdominal pain; 5) sometimes vomiting
what do these lesions look like, and where do they occur (3)?
closely resemble RAU, and most commonly occur on; 1) the soft palate; 2) pharyngeal wlal; 3) tonsilar pillars
how long do they typically take to heal?
a week
who gets hand, foot, and mouth disease?
typically children, but adults can as well
what is this disease characterized by (type of rash)?
erythematous, maculopapular rash of the skin
what areas are involved?
hands, feet, legs, arms, buttocks
what symptoms can occur (list)?
anorexia, low-grade fever, coryza, lymphadenopathy, diarrhea, nausea, and vomiting
what are the principal symptoms in most patients (over 90%)?
oral lesions
what do the lesions resemble?
where do they occur (3)?
1) tongue; 2) palate; 3) buccal mucosa
how long does it take for this infection to resolve?
10-14 days
what % of population has antibodies against HSV-I?
what may happen to patients upon initial exposure to the virus (2)?
1) develop subclinical infection; 2) develop primary herpes infection
what is the most common pattern for primary herpes infection?
acute herpetic gingivostomatitis
what do primary herpes infections begin with (2)?
1) high fever; 2) lymphadenopathy
what are they followed by, and in how long?
diffuse oral lesions in a few days
what happens to the gingiva in all cases (3)?
1) pain; 2) enlargement; 3) erythema
where in the gingiva are ulcers not uncommon, that can distinguish this form of gingivitis from those which are plaque related?
ulcerations of midfacial free marginal gingiva
what is the progression of vesicular lesions like?
multiple fragile vesicles develop and rapidly ulcerate - observation of intact vesicles are rare - these lesions frequently cluster and coalesce
what size are these lesions, and what may they resemble?
they vayr in size from a few millimeters to a centimeter and may resemble RAU closely (especially herpetiform variety)
what is the clue to the diagnosis?
involvement of bound mucosa, especially the gingival changes
where was it said these lesions can extend?
past the wetline and involve the vermilion border of the lips
if the diagnosis is in question, what test can be beneficial?
a cytological smear (if performed within 3 to 5 days)
what are therapeutic attemts most often directeed toward?
what happens to the virus after the initial infection?
it is sheltered in the nerve ganglia which innervate the area, contained by cell mediated immune response
what have been associated with increased frequency of recurrent infection (list)?
old age, pregnancy, allergy, trauma, respiratory illness, menstruation, underlying systemic disease, or malignancy
what is involvement of the lips and perioral skin known as?
herpes labialis
what precedes the clinically evident portion of the infection?
prodromal symptoms, which include burning, stinging, soreness, parasthesia and/or redness of the affected area
what follows prodromal symptoms in recurrent infection?
appearance of vesicles which rupture and form a brown crust
what are vesicles like?
filled with clear liquid, small (few mm), cluster, and coalesce
what may complicate the course (2)?
1) significant edema; 2) occasional secondary infections
is recurrent herpes labialis normally unilateral or bilateral?
unilateral (but can be either)
how long can the virus survive in gauze?
up to five hours
where else may the virus infect (above the waist) and what is this known as?
herpetic whitlow - virus may infect any unprotected finger and result in very painful recurrences to the affected digit
what is secondary herpes known as when it occurs within the oral cavity?
recurrent herpetic stomatitis
in the immunocompetent patient, where can recurrent herpes be seen?
only on the keratinized mucosa which is bound to bone
what is this information convenient in helping us distinguish, and why?
it is exactly opposite from MiRAU which occurs almost exclusively on movable mucosa
what do lesions begin like, in recurrent herpetic stomatitis, and how do they develop?
begin as pinpoint areas of erythema, which develop central zones of fibrin - lesions tend to cluster and coalesce
are they usually unilateral or bilateral?
usually localized and unilateral
how long do ulcerations of recurrent herpetic stomatitis take to heal?
5-7 days
how is herpes zoster like recurrent herpes?
it is a recurrence of a previously received infection, chickenpox, and the virus resides in sensory nerve ganglia
who does this disease affect, and what are the presenting symptoms (3)?
adults - 1) fever; 2) malaise; 3) pain - all along course of involved nerves
where do vesicles occur?
follow nerves, unilateral and anatomic
what do intraoral lesions look like initially, and what happens to them?
initially white, opaque vesicles, that ultimately rupture and form ulcerations that may resemble RAU
what type of disorder is EM and what is the cause?
acute diffuse ulcerative condition of unknown cause
where in the body can it involve (2)?
1) skin; 2) any mucosal surface
what are two common triggering events?
1) viral infections (most commonly HSV); 2) allergen exposure (often to medications)
what age/sex most commonly gets EM?
young adult males
what type of skin lesions occur (3)?
1) macules; 2) papules; 3) vesicles
where do they occur (3)?
1) extremities; 2) face; 3) neck
what is the classic lesion?
a macule which exhibits alternating rings of varying shades of erythema - "bull's eye" or "target" lesion
can oral lesions be seen in the absence of other lesions?
how serious are EM oral lesions?
out of all acute oral ulcerative conditions, primary herpes and EM produce worst symptoms - patients often bring a relative to speak for them
where do oral lesions of EM predominantly present?
on movable mucosa (but not limited to this location)
what do the individual oral lesions appear as, and what size are they?
large zones of irregular epithelial necrosis
what happens to the epithelium?
it sloughs, leaving a large, painful erosion
are these lesions normally solitary or multiple?
often numerous and diffuse
can involvement extend past the wetline onto the vermillion border?
what is it called when lesions involve the skin and mucosal surfaces of eye, mouth, and genital areas?
Stevens-Johnson Syndrome