Oral Path Cudental White Lesions

Front 1

An African American patient presents with an asymptomatic white opacification bilaterally on his buccal mucosa. It has a wrinkled, corrugated appearance which disappears when stretched. This is most likely _______.

Back 1

leukoedema

Front 2

This rare, non-treatable disease is due to an autosomal nt keratin mutation which manifests itself bilaterally and symmetrically on the buccal mucosa forming deep white folds or corrugations which are asymptomatic. Similar pathology is found on other mucosal tissues of the body such as the esophagus, anus and . Definitive dx is bade via family hx or biopsy.

Back 2

WSN (white sponge nevus)

Front 3

HBID, an acronym for ___________________, is an extremely rare autosomal nt disease characterized by foamy conjuctival ______ in the corner's of the eye along with white lesions of the buccal mucosa similar to white sponge nevus.

Back 3

hereditary benign epithelial dyskeratosis, plaques

Front 4

Eric presents with 2-3 mm white, cobblestone-like papules on his hard palate. Before giving him a hard time for how bad he smells you notice his fingernails are splintering and has hyperkeratotic papules on his face and trunk. These sx's, including bad odor, are sx's of ____________.

Back 4

follicular keratosis

Front 5

Which is not a hereditary white lesion: HBID, follicular keratosis, WSN, leukoedema.

Back 5

leukoedema (not hereditary) rest are autosomal nt

Front 6

A patient presents with a "callus" like hyperkeratosis on his edentulous ridge, lateral tongue and buccal mucosa. This is most likely a case of _________.

Back 6

Frictional hyperkeratosis (increased thickness of the keratin layer)

Front 7

Frictional hyperkeratosis is premalignant. T/F

Back 7

FALSE, if there is no obvious etiology biopsy just in case

Front 8

A former smokeless tobacco chewer presents with a persistent white lesion which was biopsied 4 weeks ago. The histo slide showed acanthosis, hyperkeratosis and "_____" formation. You inform the patient there is a ___ risk of dysplasia/malignant transformation.

Back 8

chevron, small

Front 9

_________ carcinoma is most diagnosed on male smokeless tobacco users > 55 years old.

Back 9

Verrucous

Front 10

A patient presents with a white keratinization of the palate with pinpoint red spots. He couldn't stop talking about how good pipe smoking is. He most likely has ___________ and the red pinpoint spots are ________.

Back 10

nicotinic stomatitis, minor salivary duct openings

Front 11

An HIV patient presents with hyperkeratotic plaque-like lesions on the lateral tongue. Upon reviewing her med hx you find she also has EBV. The histo shows nuclear viral inclusions. She is most likely suffering from _________.

Back 11

oral hairy leukoplakia

Front 12

T/F Oral hairy leukoplakia is caused by HIV.

Back 12

False EBV, although 80% are HIV+

Front 13

T/F Oral hairy leukoplakia and hairy tongue are one in the same.

Back 13

FALSE

Front 14

A patient presents with thick matted, brownish-white (sometimes black) dorsum of the tongue due to the overgrowth of the ______ papillae. Her hx reveals she is a smoker and is currently taking antibiotics. She may have ________.

Back 14

filiform, hairy tongue

Front 15

You are about to misdiagnose a patient with superficial white slough with pemphigus or pemphigoid when she tells you it started a few weeks ago when she switched tooth paste brands. You consult her to change back to the old brand because she has __________.

Back 15

dentifrice-associated slough

Front 16

6 months later, the same patient presents with leukoplakia of the maxillary vestibule and alveolar mucosa. She said she followed your directions and bought a different brand tooth paste called Viadent at an herbal store. You know she is suffering from ________.

Back 16

Sanguniaria-related keratosis

Front 17

A 40 year old male smoker presents with white patches on the mandibular and buccal mucosa that can't be rubbed off. He is likely suffering from ________ and a biopsy should be taken since ____ % eventually undergo malignant transformation due to dysplasia.

Back 17

idiopathic leukoplakia, 5-15

Front 18

Histological features of moderate dysplasia include: increased _:_ ratio, _______ pleomorphism and increased or abnormal ______.

Back 18

N:C, nuclear, mitosis

Front 19

Carcinoma-in-situ invades the basement membrane. T/F

Back 19

False, however is pre invasive, full thickness dysplasia

Front 20

SCCA invades the basement membrane. T/F

Back 20

TRUE

Front 21

Tx for idiopathic leukoplakia includes _______ for large lesions, ________ if no dsyplasia, ________ for mild dysplasia and ______ for moderate to severe along with counseling for smoking cessation .

Back 21

multiple biopsies, biopsy PRN, excision, complete excision

Front 22

From highest % to lowest, dysplasia risk of idiopathic leukoplakia: lower lip, tongue, floor of mouth.

Back 22

floor of mouth > tongue = lower lip

Front 23

Idiopathic leukoplakia: most common intraoral location.

Back 23

mandibular mucosa > buccal mucosa

Front 24

A 50 year old "butt" white male presents with a blurring of the vermillion and hyperkeratotic plaques on his ing, mottled lower lip. Due to sun exposure he may have ________. Due to it's severity a biopsy was taken revealing atrophic epithelium, hyperkeratosis and solar ________.

Back 24

Actinic (solar) Chelitis, elastosis

Front 25

T/F Actinic chelitis is a precursor to SCCA and malignantly transforms 6-10% of the time.

Back 25

TRUE

Front 26

A female patient presents with asymptomatic, erythematous, well-demarcated areas of papillary atrophy surrounded by yellow-white border which "migrate" with time. You reassure the patient that her condition in benign and fairly common (1-3% population). She is diagnosed by clinical findings with __________.

Back 26

geographic tongue aka migratory glossitis aka erythema migrans

Front 27

A middle aged partially edentulous patient presents with bilateral, interlacing white keratotic line lesions with a "wax and wane" appearance on the buccal mucosa. You also notice she has cutaneous lesions on her knees and elbows along with fingernail changes. She is likely suffering from __________, and the keratotic lines are referred to as ________.

Back 27

Reticular Lichen Planus (most common form), Wickham's striae

Front 28

Lichen planus is a mucocutaneous disease caused by a T-cell mediated "hypersensitivity" which causes ________ of basal epithelial cells (civatte bodies) and degradation of the cell layer. Histologically saw toothed ________ and band like infiltrates of _______ and at times hyperkeratosis are present.

Back 28

apoptosis, rete pegs, lymphocytes

Front 29

Oral lichen planus appears in what 3 forms. These forms may coexist. T/F

Back 29

reticular (most common), plaque (normally on dorsum of tongue) and erythematous/erosive. True

Front 30

Erythematous/erosive lichen planus presents as ulcerating atrophic reddened areas with fine white striae on the periphery that may also be confined to the __________. Clinically it can be confused with pemphigoid, pemphigus and oral lichen planus.

Back 30

gingiva

Front 31

SLE, SCLE or CCLE (discoid): scaly erythematous skin patches, no systemic involvement, non-characteristic oral appearance.

Back 31

CCLE (chronic cutaneous)

Front 32

SLE, SCLE or CCLE (discoid): multi-system disease, butterfly rash.

Back 32

SLE

Front 33

SLE, SCLE or CCLE (discoid): Women 8:1, arthritis, pulmonary, and renal problems.

Back 33

SLE

Front 34

SLE, SCLE or CCLE (discoid): AB prophylaxis required due to Libman-Sacks endocarditis.

Back 34

SLE

Front 35

SLE, SCLE or CCLE (discoid): lesions in sun exposed areas, no scarring, musculoskeletal problems.

Back 35

SCLE (subactute cutaneous)

Front 36

SLE, SCLE or CCLE (discoid): serum ANA and anit-double stranded DNA.

Back 36

all esp. SLE

Front 37

An infant presents with mildly burning white soft plaques which rub off. It appears to be fungal in origin; she may be suffering from ________.

Back 37

Acute Pseudomembranous Candidiasis (Thrush)

Front 38

Also known as antibiotic stomatitis this fungal disease presents as generalized red patches and depapillation of the dorsal tongue.

Back 38

Acute erythematous

Front 39

aka "denture sore mouth"

Back 39

chronic erythematous candidiasis

Front 40

Angular cheilitis occurs frequently in edentulous patients due to their loss of ___ which causes deep folds at the commissures which trap saliva, fungi and bacteria (staph aureus).

Back 40

VDO

Front 41

Hyperplastic tissue response to chronic candidal infection causes __________ candidiasis.

Back 41

Chronic hyperplastic

Front 42

Involving an area anterior to the circumvallate papilla in the shape of a rhomboid, this form of candidiasis also causes a "kissing lesion" on the ________.

Back 42

Median rhomboid glossitis, hard palate

Front 43

Form of candidiasis involving mucous membranes and skin.

Back 43

Mucocutaneous

Front 44

After a sample is scraped from the area, fixed and stained confirming the presence of fungi, which Tx should not be used to treat candidiasis: fluconazole, clotrimazole, nystatin pastilles, nystatin topical powder, penicillin.

Back 44

penicillin

Front 45

Mucosal burns may be thermal, chemical or electrical. At times a ____ must be placed to prevent contracture.

Back 45

splint

Front 46

A patient presents with pallor and stiffening of his oral mucosa which restricts him from opening. You find he runs a local Quick-E-Mart which sells paan, or betel quid. You inform the patient that his condition is precancerous and he will need to return for frequent re-evaluations because he is suffering from ____________.

Back 46

Submucous Fibrosis Doh!

Front 47

Fordyce granules are ectopic sebaceous glands found on the buccal mucosa; they are a variant of normal. T/F

Back 47

True; True

Front 48

Ectopic lymphoid tissue may be found at the floor of the mouth, ventral tongue, soft palate and palatine tonsils. The key to ruling out pathology is to see if they are _______.

Back 48

bilateral

Front 49

Oral lymphoepithelial cysts are submucosal masses and, as the name suggests, are a keratin-filled cysts with lymphoid tissue in the cyst wall. They are commonly found on the _______ and ______.

Back 49

floor of the mouth, ventral-posterior-lateral tongue

Front 50

Gingival cysts are more common in s than newborns: in s they commonly appear near the mandibular PM-canine area of attached gingiva and in newborns as single-multiple 2mm off-white nodules on the midline or other areas of the gingiva. T/F

Back 50

False: True

Front 51

A ______ may be found at the apex of a non-vital tooth, or less likely at the base of a periodontal pocket and is aka "gum boil."

Back 51

Parulis

Front 52

A lipoma is a malignant adipocyte neoplasm. T/F

Back 52

False - benign