Oral Pathology Ch.3-2

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Oral Pathology Ch.3-2
2011-03-14 17:38:14
Dixon OP

Ch.3-2 Dixon OP
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  1. very tiny (1 – 2 mm)
    resemble ulcers caused by the herpes simplex virus
    painful and develop anywhere in oral cavity usually grouped
    * ulcers from herpes simplex appears on mucosa fixed to bone – palate and gingival
    “Bound down mucosa”
    hard to distinguish from 1° herpesway to distinguish is that with
    Herpetiform Aphthous
  2. Ways to distinguish is that with 1° herpes:
    Fever, malaise, fiery red gingiva, Does Not respond to topical appllication of liquid tetracycline
  3. “hives” appears as multiple areas of well-demarcated swellings associated with itching (pruritus)
  4. caused by localized areas of vascular permeability in superficial CT beneath epithelium
  5. diffuse swelling of tissues caused by permeability of deeper blood vessels but no itching
    - usually the lips are affected
  6. both are similar lesions
    Tx includes use of Antihisamines (Benadryl-diphenhydramine)
  7. lesions resulting from the direct contact of an allergen with the skin or mucosa
    -Type IV hypersensitivity
    -most common cause – latex; but can be caused by other things to: local anesthetics, acrylic, metals
    Tx – topical/systemic corticosteroids
    Contact Mucositis/Dermatitis
  8. mucosa comes erythematous/edematous accompanied by burning/itching
  9. erythematous, swelled and becomes encrusted with scaly, white epidermis
  10. lesions that appear in the same site each time a drug is introduced
    subside when drug is removed
    single or multiple slightly raised reddish patches or clusters of macules on skin
    pain & itching
    Type III hypersensitivity
    Tx – discontinue use of drug after it’s been identified
    Fixed Drug Eruptions
  11. most severe form of erythema multiforme?
    Setevens-Johnson syndrome
  12. mucosal lesions more extensive and painful; genital mucosa/mucosa of eyes; lips generally encrusted/bloody
    eye lesions can lead to blindness
    Steven-Johnson syndrome
  13. some possible causes: herpes simplex, TB, histoplasmosis, drugs – barbiturates and sulfonamides
    Tx – topical corticosteroids; systemic steroids
    Erythema Multiforeme
  14. -acute, self-limited disease affecting the skin and mucous membrane
    -occurs in young adults and affects men more commonly than women
    -characteristic skin lesion – “Bull’s eye or target” – concentric rings of with normal skin color
    - can affect oral cavity with or without the skin – oral – ulcers
    -ulcers on lateral borders of tongue; crusted and bleeding lips
    -explosive onset
    Erythema Multiforme
  15. Straie?
    Wickhan's sraie
  16. if the epithelium separates from the CT and erosions, bullae, or ulcers form its called?
    erosive and/or bullous lichen planus
  17. -benign, chronic disease affecting the skin and oral mucosa
    -characteristic pattern of interconnecting lines (striae) resembling the pattern of the plant as it grows on rocks and trees (lace appearance)
    -common in middle age with slight female predominance
    Lichen Planus
  18. this can be caused by lichen planus?
    desquamative gingivitis
  19. -skin lesions of lichen planus – 2 – 4 mm papules located: lumbar region, flexor surfaces of wrist, anterior surface of ankles
    -dx made upon clinical appearance and histologic appearance of biopsy
    -chronic disease that is treated symptomatically
    -Tx with topical corticosteroids
    -Suggested that patients with lichen planus are more at risk to develop Squamous Cell Carcinoma
    Lichen Planus
  20. -unknown cause
    -antigenic marker HLA-B27 present suggestive of genetic influence
    -more prevalent in men than women
    -develops 1 – 4 weeks after venereal or GI infection
    Reiter's syndrome
  21. -radrographically – periosteal proliferation on heels, ankles, metatarsals, phalanges, knee, and elbows
    -aphthous-like ulcers, erythematous lesions, and geographic tongue-like lesions in oral cavity
    -lasts from weeks – months
    -Tx with ASA (aspirin) or NSAIDS (non-steroidial anti-inflammatory drugs)
    Reiter's Syndrome
  22. Also called Langerhans cell granulomatosis
    Histiocytosis X
  23. 3 entities grouped under Histocytosis X:
  24. -acute fulminating disorder affecting children younger than 3 years
    -resembles a lymphoma – rapid and fatal
    -some times responds to chemotherapy
    Letterer-Siwe Disease
  25. -children less than 5 years
    -classic triad in 25% of patients:
    -single-multiple “punched-out” (RL) in skull
    -unilateral or bilateral exophthalmos
    -diabetes insipidus
    -oral manifestations
    Hand-Schuller-Christian Disease
  26. sore mouth, halitosis, gingivitis, loose teeth, non-healing extraction sites, appearance of advanced periodisease
    oral manifestations
  27. -older children/adults, males
    -skull/mandible involved
    -lesion resembles periodontal disease or PA inflammation or as a well-circumscribed (RL) with or without sclerotic borders
    -Tx – conservative surgical excision and radiation
    Eosinophilic Granuloma
  28. These diseases causes tissue damage because the immune system treats the person’s own cell’s and tissues as antigens
  29. -affects salivary and lacrimal glands
    -casue unknown
    -50% have other autoimmune diseases – rheumatoid arthritis/systemic lupus
    -major/minor salivary glands involved – 50% have Parotid enlargement
    -also susceptible to lymphoma
  30. eye involvment can create this?
    abnormal visual intolerance to light
    • photophobia
  31. 20% of patients also have this?
    disorder afffecting the fingers and toes
    • Raynaud's phenomenon
  32. 90% have a positive reaction to this?
    an antibody to IgG
    • rheumatoid factor
  33. lab abnormalities include:
    -mild anemia
    -dec WBC count
    -elevated erythrocyte sedimentation rate
    -diffuse elevation of serum immunoglobulins
    *dx made when 2 of the 3 components are present: xerostomia, rheumatoid arthritis, or keratoconjunctivitis sicca
  34. -acute/chronic inflammatory autoimmune disease of unknown cause
    -syndrome that includes a wide spectrum of disease activity and signs and symptoms ranging from skin lesions to wide spread, debilitating, life threatening disease with multiple organ involvement
    -both cellular and humoral immunity are impaired
    -85% of individuals have skin lesions
    -classic “Butterfly” rash occurs across the bridge of the nose, and some lesions on the fingertips
    Systemic Lupus Erythematosus
  35. -arthritis/myositis can occur
    -psychoses/depression are signs of CNS involvement – seizures can be present
    -pericarditis, cardiac arrhythmias, & endocarditis may be seen late in the disease
    -kidney involvement
    -dx based on classic multiorgan involvement and presence of antinuclear antibodies in serum
    Systemic Lupus Erythematosus
  36. Tx’s: -ASA/NSAIDS for mild symptoms
    -Hydroxychloroquine (anitmalarial)
    -Corticosteroids with azathioprine & cyclophosphamide
    - Excellent prognosis with mild symptoms, but can be fatal
    -Kidney failure is cause of death in SLE -SBE prophylaxis recommended (sub-acute bacterioendocarditis)
    Systemic Lupus Erythematosus
  37. Pemphigus Vulgaris is characterized by intraepithelial blister formation that results from breakdown of the cellular adhesion between epithelial cells?
  38. -severe, progressive autoimmune disease affecting the skin and mucous membranes
    -most frequently seen type of pemphigus
    -oral lesions appear as shallow ulcers to fragile vesicles or bullae
    Pemphigus Vulgaris
  39. Pemphigus Vulgaris is characterized by this? Sloughing with finger pressure
    Nikolsky's sign
  40. What are the 3 types of pemphigus:
    vegetans, foliaceus, and erythmatosus
  41. -“benign mucous membrane pemphigoid” – BMMP
    -chronic autoimmune disease affecting oral mucosa, conjunctiva, genital mucosa, and skin (requires referral to multiple specialists)
    -lesions occur as a result of cleavage of epithelium from underlying CT (acantholysis)
    -heals with scaring
    Pemphigus Vulgaris
  42. -“benign mucous membrane pemphigoid” – BMMP
    -chronic autoimmune disease affecting oral mucosa, conjunctiva, genital mucosa, and skin (requires referral to multiple specialists)
    -lesions occur as a result of cleavage of epithelium from underlying CT (acantholysis)
    cicatricial pemphigoid
  43. most common site is gingiva -appearance from erythema to ulceration and involves both free/attached gingival
    -gingival lesions termed – desquamative gingivitis
    Cicatricial Pemphigoid
  44. Dx made by biopsy/histologic examination
    -Direct immunofluorescence shows a linear pattern at basement membrane
    -Tx: topical/systemic corticosteroids
    -Eye damage is possible – can lead to blindness
    Cicatricial Pemphigoid
  45. -very similar to BMMP with incidence occurring in older patients > 60 years
    -Tx – NSAIDS – corticosteroids
    bullous Pemphigoid
  46. -chronic recurrent autoimmune disease consisting 1° of oral ulcers, genital ulcers, and ocular inflammation
    -around 30 years old
    -oral ulcers very similar to aphthous ulcers
    -genital ulcers are small and located on scrotum or base of penis labia majora
    -skin lesions are papular and pustulate and occur on the trunk and limbs
  47. -Dx: 2 of 3 need to be present [oral, genital, ocular]
    -Pustule developing after needle puncture is highly suggestive
    -Tx: systemic/topical corticosteroids