ORAL PATH. 3 REVIEW EXAM 1

Take history

Case 1. A 42-year-old male is asthmatic and presents with diffuse white plaques on the palate. 1a. What is the first thing you would do?

Steroid Inhaler

1b.What would be the most likely cause of the white lesion?

Pseudomembranous candidiasis

1c.What is the MOST appropriate diagnosis?

White plaques that wipe off

1d.What is a defining feature of Pseudomembranous candidiasis?

Burning and metallic taste

1e.What would be the symptoms?

Nystatin oral suspension

1f. Which is the best first-line prescription therapy?

Rinse mouth

1h.Which management step is essential after inhaler use?

leukoedema

Case 2. A 33-year-old woman reports burning and irritation on the right buccal mucosa with white reticular striations with erythema. 2a. Which of the following is NOT in the differential?

Drug induced lichenoid mucositis

Oral lichen planus

Cinnamon hypersensitivity

Leukoedema

Unilateral lesions adjacent to offending agent

2b. What feature supports a cinnamon-induced lichenoid mucositis?

Stopping the cinnamon-containing product

best treatment for cinnamon-induced lichenoid mucositis?

Flucinonide gel

2d. If symptoms persist after removing the allergen, which medication is appropriate?

Acyclovir tablets

Nystatin mouth rinse

Fluocinonide gel

Mycelex troches

Desquamative gingivitis

Case 3. A 55-year-old woman presents with painful peeling gingiva. Gingiva is erythematous with sloughing epithelium. 3a. What is the term to describe the gingiva?

Pemphigus vulgaris, mucous membrane pemphigoid, erosive LP

3b. Which of the following is the correct differential diagnosis?

Primary herpetic gingivostomatitis, erosive LP, lichenoid mucositis

Erosive LP, systemic lupus, erythema multiforme

Pemphigus vulgaris, mucous membrane pemphigoid, erosive LP

Mucous membrane pemphigoid, reticular LP, pemphigus vulgaris

Incisional biopsy with DIF testing

3c. How would you confirm the disease?

Subepithelial blister formation

3d. Which feature is characteristic of mucous membrane pemphigoid?

Dexamethasone oral solution

3e. What is the most appropriate initial therapy?

Dexamethasone oral solution

Penicillin tablets

Mycelex troches

Acyclovir tablets

Nystatin mouth rinse

3f. Which medication should also be prescribed with corticosteroids in this case?

Mycelex troches

Prednisone tablets

Nystatin mouth rinse

Acyclovir tablets

Fordyce granules

Case 4. Asymptomatic small yellow-white papules on the buccal mucosa of a 60-year-old man. 4a. What is the diagnosis?

Ectopic sebaceous glands

4b. What is the etiology of this lesion?

No treatment

4c. What is the management:

SCC and high grade dysplasia

Case 5. A 70-year-old smoker presents with an erythroleukoplaic lesion on the floor of the mouth for 6 months. He complains of pain and is unable to wear his denture. 5a. What is the most likely diagnosis?

Has a high malignant transformation

5b. Why is erythroleukplakia concerning?

Follow up

5d. What is the management of mild dysplasia?,

Moderate dysplasia

5c. Atypical cells reach 2/3 of the epithelium thickness. What is the diagnosis?

Immediate incisional biopsy

5e. What is the management of this lesion?

Proliferative verrucous leukoplakia (PVL)

what is the most likely diagnosis?

Premalignant

6b. Why is PVL concerning?

Wipes off

6c. All of the following are unique clinical features of PVL EXCEPT:

Multiple locations and can spread

Gingiva is usually involved

Wipes off

High recurrence rate

Immediate incisional biopsy

6d. What is the appropriate management?

Melanocytic nevus and melanotic macule

Case 9. A 45-year-old female with a small well-demarcated brown macule on the hard palate was discovered during a dental examination. 9a. What would be the differential diagnosis?

Melanocytic nevus and melanotic macule

Melanoma and amalgam tattoo

Amalgam tattoo and blue nevus

Melanoma and melanotic macule

Symmetric, uniform pigmentation

9b. What would be a clinical feature of a benign brown pigmented lesion?

Observation

9c. What would be the management?

Melanoma

Case 10. A 62 year old male with a painful dark lesion on the maxillary gingiva that has increased in size the past few months. 10a. What is the most likely diagnosis?

take Xray and perform incisional biopsy

10b. What is the appropriate next step after clinical examination?

Irregular borders and variegated color

10c. Which of the following descriptions meets the ABCED criteria for this lesion?

Symmetry and well defined

Irregular borders and variegated color

Uniform color and size

Evolution remained stable

Early melanoma is often curable with excision

10d. Which of the following statements about melanoma is correct?

It only develops from moles

It is the least dangerous skin cancer

It does not occur in darker skin tones

Early melanoma is often curable with excision

Major aphthous ulcer

Case 11. A 21 year old female with a painful ulcer on soft palate that has appeared before and disappeared after 10 days. 11a. What would be the diagnosis?

Occur on non-keratinized mucosa

11b. Which of the following is a unique clinical feature of aphthous ulcers?

Occur on keratinized mucosa

Are contagious and highly infectious

Occur on non-keratinized mucosa

Cause burning and metallic taste

Clobetasol gel

11c. What would be the appropriate medication for aphthous ulcer ?

Acyclovir

Clobetasol gel

Nystatin mouth rinse

Mycelex troches

Recurrent herpes and herpes zoster

Case 12. A 66-year-old male developed these lesions following the flu. 12a. What is the most likely differential diagnosis?

shingles dermatomal distribution with lesions not crossing the midline

12b. Which of the following features best differentiates shingles (herpes zoster) from recurrent herpes simplex infection?

Varicella-zoster virus

12c. What is the cause of shingles?

Epstein–Barr virus (HHV-4)

12d. What type of virus is varicella-zoster virus (VZV)?

Ramsay Hunt syndrome

12e. Which rare type of shingles affects the facial nerve causing facial paralysis?

In the ear canal and on the ear

12f. Where do the vesicles typically appear in Ramsay Hunt syndrome?

Begin steroids and antivirals within 72 hours

12g. What is an important management step for Ramsay Hunt syndrome?

nicotine stomatitis

Case 13. A 57-year-old male presents for a routine dental checkup. Patient smokes a pipe. 13a. What is the MOST likely diagnosis based on the clinical presentation?

chronic heat irritation from smoking

13b. What is the primary etiologic factor responsible for this condition?

lesion is benign

13c. The patient is concerned about the possibility of cancer because he has been smoking a pipe for the past 20 years. Which of the following is TRUE about the lesion?

lesion is curable cancer

lesion is premalignant

lesion is dyplastic

lesion is benign

advise smoking cessation and monitor

13d. What is the most appropriate management for this patient?

epithelial dysplasia

The biopsy results reveal abnormal epithelial cells. What is the BEST term to describe the findings?

epthelial atypia

squamous cell carcinoma

eputhelial dysplasia

verrrucous carcinoma

prescribe antifungal therapy

Which is the most appropriate management?

rinse with water after inhaler

stop use of inhaler

change to different inhaler

prescribe antifungal therapy

drug induced

What is the most likely the etiology of the discoloration

ectodermal dysplasia

Which of the following diagnosis is most likely?

congenital syphilis

regionalodontodysplasia

ectodermal dysplasia

cleidocranial dysplasia

adjacent to ulcer

Which of the following is the BEST area for biopsy?

mucosa on right

adjacent to ulcer

no biopsy

within the biopsy

erethema multiforme

what is the most likely diagnosis?

herpes simplex 1 (not varicella due to age?)

What is the most likely causative agent?

location on lateral tongue

What presentation of the lesion worsens the diagnosis?

remove amalgam restoration

What is the most appropriate next step?

pseudomembranous candidiasis

All of the following are in the differential diagnosis EXCEPT:

pseudomembranous candidiasis

graft v host

reticular lichen planus

idiopathic leukoplalkia

lichen planus

what is the most likely diagnosis?

nikolsky sign

Which of the following signs is demonstrated in this patent's physical exam findings?

prophy jet with abrasive paste

Which of the following is NOT appropriate management?

prophy jet with abrasive paste

cavitron

manual curretage

alcohol-free rinse

attached gingiva

Where is the most likely location of the lesions?

epstein barr virus (oral hairy leukoplakia)

What is the causative agent?

mild dysplasia

atypical cells that are confined to the bottom 1/3 of epithelial thickness

geographic tongue

diagnosis of this lesion that keeps changing location

surgical removal

how would you manage carcinoma in situ

cheewing tobacco

which of the following agents does NOT cause lichenoid mucositis

toothpaste

medication

cinammon

chewing tobacco

lisinopril

all of the following could be prescribed for autoimmune disease EXCEPT

dexamethasone

clobetosol

lisinopril

prednisone

biopsy

what is the management if there is a focal area that looks different

due to ectopic salivary glands

which of the following is FALSE regarding this lesion:

asymptomatic

due to ectopic salivary glands

no management

can occur on the lip

lymphoid hyperplasia

which of the following is NOT in the differential diagnosis of a yellow lesion

lymphoepithelial cyst

lymphoid hyperplasia

lipoma

sialolith

E, O, A, S

arrange the lesions from high to low risk for malignant transformation:

(O) oral submucous fibrosis, (E) erythroplakia, (A) actinic cheilosis, (S) smooth leukoplakia

herpetiform apthous ulcer

what is the diagnosis of this lesion that occurs of MOVABLE mucosa

incisional biopsy

what is the management of this lesion

melanoma

what is the most likely diagnosis

mucous membrane pemphigoid

separation of the epithelium from underlying mucosa is most characteristic of which diagnosis

malignancy

the lesion has been present for 3 weeks, what is the concern with this lesion

geographic tongue

what is the diagnosis

see if lesion wipes off

what is the first step you would take to reach a diagnosis of this lesion

observe/follow up

patient is asymptomatic, what is the management?

HSV 1

what is the cause of this lesion

targetoid

what is the description of this skin lesion