Path Midterm 2 Lecture 17

Front 1

Lichen planus:

5 other clinically similar diseases?

Back 1

Lichen Causes Freaking LAG

1) Lichenoid contact stomatitis
2) Contact stomatitis
3) Foreign body reactions
4) Lupus
5) Allergic mucosal reaction
6) Graft versus host disease

Front 2

Lichen planus:

1) Site?
2) Clinical features?
3) 2 types?
4) Does LP have malignant potential?

Back 2

1) Skin, oral mucosa
2) 4 P's - purple, pruritic, polygonal, papules. Interlacing white lines, lace-like reticular pattern (Wickham's striae)
3) Reticular LP, erosive LP
4) Controversial - likely erosive LP if anything. This is why it's *important to do a periodic re-evaluation*

Front 3

Reticular Lichen Planus:

1) What is more common, reticular or erosive?
2) Site?
3) What does it look like?
4) How do lesions occur?
5) Treatment?

Back 3

1) Reticular
2) Any oral site - posterior buccal mucosa (bilateral)
3) Interlacing white lines (Wickham's striae), white papules. Dorsal tongue - white plaques
4) Flare up - wax and wane
5) Periodic re-evaluation every year

Front 4

Erosive lichen planus:

1) Usually ___
2) Clinical appearance?
3) Treatment?

Back 4

1) Symptomatic
2) Atrophic, erythematous patches (erosion) +/- ulceration. Interlacing white lines (reticulations) at periphery. Gingiva - desquamative gingivitis
3) Corticosteroids (topical > systemic), periodic re-evalu every 3-6 months

Front 5

Histology of lichen planus? What does IIF/DIF show?

Back 5

Lichen planus is HP, BH!

1) Hyperkeratosis
2) Pointed "saw-tooth" rete rdiges
3) Band-like layer of lymphocytes
4) Hydropic degeneration

IIF/DIF shows shaggy band of fibrinogen at BMZ

Front 6

Graft-versus-host-disease:

1) Treatment?
2) 3 sources of stem cells?
3) Indications?
4) Etiology?
5) Occurrence, severity dependent on?
6) What causes the least post-transplant complications?
7) Exceptions?

Back 6

1) Patient's own autologous stem cells or allogeneic matched donor stem cells infused into patient - infused stem cells reconstitute patient's marrow
2) Bone marrow, peripheral blood, cord blood
3) Hematologic disorders
4) Engrafted donor stem cells attack host cells
5) Histocompatibility HLA match - better match = less severe
6) Find the best HLA match
7) Leukemia - graft-versus-leukemia effect

Front 7

Graft versus host disease:

1) Incidence?
2) Site of acute GvHD?
3) Site of chronic GvHD?
4) Histology?
5) Treatment?
6) Dental management?
7) BMT patients have an increased risk of?
8) What's necessary?

Back 7

1) 50% patients receiving allogeneic BMT
2) Skin, GI tract, liver
3) Multiorgan
4) Like lichen planus
5) Prevent through careful matching
6) Same pre-tx recommendations as those undergoing chemo, radiation, IV bisphosphonates
7) Oral epithelial dysplasia, squamous cell ca
8) Periodic re-evaluation

Front 8

Symptoms of acute graft versus host disease?

Back 8

1) Skin: maculopapular rash, severe sloughing (burn)
2) GI: Diarrhea, nausea, vomiting, abdominal pain
3) Liver: Early liver dysfunction

Front 9

Chronic GVHD:

1) Mimics?
2) Symptoms?
3) What does it look like in the oral cavity?

Back 9

1) Autoimmune diseases
2) Skin - lesions of lichen planus/lupus/systemic sclerosis
GI: Same as acute
Liver: Jaundice, hepatitis, cirrhosis
Eyes: Dryness, Sjogren's
3) ~lichen planus, pyogenic granuloma like lesion

Front 10

Psoriasis:

1) Etiology?
2) Site?
3) Clinical features?
4) Histology?
5) How to treat severe psoriasis?
6) Increased risk of?

Back 10

1) Immune-mediated, increased proliferation of skin keratinocytes. Activation of T lymphocytes
2) Skin
3) Well-demarcated, erythematous plaques w/ silver scale, symmetric, periods of exacerbation and remission (winter?). Variable appearance.
4) ~Erythema migrans (ie psoriasiform mucositis), elongated rete ridges, collections of intraepithelial neutrophils (Munro abscesses)
5) TNF-alpha inhibitors, T-cell receptor agents
6) Cutaneous squamous cell carcinoma