Upper GI

Question 1

What drugs is implicated in this condition?

Answer 1

Phenytoin

Question 2

What condition does this patient have?

Answer 2

Diabetes

[Periodontitis]

Question 3

Identify this condition and mutation associated with it.

Answer 3

Peutz-Jegher syndrome, SKT11 gene mutation

Question 4

Identify this lesion

Answer 4

Oral Melanoma

Question 5

What drug is implicated in this condition?

Answer 5

sulphonamides

[Stevens-Johnson syndrome]

Question 6

Identify this lesion and list its 4 causes?

Answer 6

Target lesions seen in Erythema multiforme

Etiologies:

1. HSV
2. Drugs
3. Carcinoma and Lymphoma
4. Collagen Vascular disease

Question 7

Describe the lesion seen in Erythema multiforme?

Answer 7

Self limited symmetrical lesion, seen especially on the hands. [+/- mucous membrane involved]

Question 8

What condition does this patient have?

Answer 8

Addison disease

Question 9

What abnormality might indicate pharyngeal cancer?

Answer 9

Asymmetric tonsils or lingula

Question 10

Age group associated with this lesion

Answer 10

frquenct in first two decades

Question 11

Diagnose and describe this lesion

Answer 11

Aphthous Ulcers

• Superficial mucosal ulcer that have a hyperemic base covered by a thin exudate and rimmed by a narrow zone of erythem
• Resolves spontaneously 7-10 days [can recurr]

Question 12

Epidemiology of this condition

Answer 12

• Unknown etiology, tends to be familial
• affects 40% of population
• frequent in first 2 decades of life

[Aphthous Ulcers]

Question 13

What conditions are associated with this lesion?

Answer 13

Celiac

IBD

Behcet disease

Question 14

What are the viral and bacterial causes of this condition?

Answer 14

Bacterial:

• Streptococcus pharyngitis [Group A b-hemolytic streptococcus]

Viral:

• Adenovirus
• Rhinovirus
• Influenza
• Coronavirus
• RSV

Question 15

What is this lesion? Describe it.

Answer 15

Tonsilitis [Viral]

Swelling and redness

Question 16

What is this lesion? Describe it

Answer 16

Bacterial tonsilitis

Exudate

Question 17

How to diagnose this lesion?

Answer 17

Monospot test

[quick screening Gray-white exudative test detects heterophil membrane antibodies caused by the EBV]

Question 18

List all you know about this condition

Answer 18

1. Epstein-Barr virus (EBV)
2. Children and young adults
3. Classic triad: fever, pharyngitis, lymphadenopathy

Question 19

What is a complication of this condition?

Answer 19

respiratory failure due to pseudomembrane formation or aspiration

Question 20

What is the causative organism?

Answer 20

C diphtheria

Question 21

How to prevent this condition?

Answer 21

Immunization

Question 22

What is the cause of this condition and how is it spread?

Answer 22

• Cause: Group A β-hemolytic streptococci
• Spread: by inhalation

Question 23

Describe the presentation of a patient with this condition

Answer 23

1. Pharyngitis
2. Fever
3. Rash

Question 24

What condition does this patient have?

Answer 24

Scleroderma

Question 25

What condition does this patient have?

Answer 25

SLE

Question 26

What condition does this patient have?

Answer 26

Sjögren syndrome

Question 27

What condition does this patient have and what other signs might we see in the oral cavity?

Answer 27

**IDA** Signs of IDA: * atrophy * mucosal pallor * atrophic glossitis

Question 28

What is the sign and what does this point to?

Answer 28

* Magenta tongue * Pernicious anemia

Question 29

What condition does this point to ?

Answer 29

* hematopoietic neoplasms or coagulopathies * signs: * Hemorrhage * Gingival bleeding

Question 30

Diagnose

Answer 30

Kaposi sacroma [associated with HIV] Description of lesion: * Spindle cells * Slit-like vessels with blood

Question 31

Diagnose

Answer 31

Kaposi sacroma [red/purple nodule]

Question 32

Diagnose

Answer 32

HIV-related neoplasm: Lymphoma [aggressive b cell lymphomas]

Question 33

List all oral lesion associated with HIV?

Answer 33

1. Aphthous ulcers 2. Fungal, Viral and Bacterial infections 3. Neoplasms: * Lymphoma * Kaposi sarcoma

Question 34

What is the lesion?

Answer 34

Hairy leukoplakia (Epstein-barr virus)

Question 35

Describe the lesion

Answer 35

* superficial vesicles and bullae that rupture easily, leaving shallow erosions covered with dried serum and crust * Oral lesions persists for months before dermatological lesions appear

Question 36

Diagnose this lesion and explain the pathophysiology of this disease

Answer 36

* pemphigus vulgaris * antibody in pemphigus vulgaris reacts with desmoglein 3, a component of desmosomes of lower epidermis

Question 37

What is this lesion and what conditions is it associated with?

Answer 37

1. Pyostomatitis Vegetans 2. Ulcerative colitis and Crohn's disease

Question 38

Describe this lesion

Answer 38

[lichen planus] **Oral:** * white net-like lesion in buccal mucosa * lesions resolves within 1-2 years leaving behind post-inflammatory hyperpigmentation **Dermatologic:** * Papular purple lesions [violaceous color] * Lesions symmetrically distributed, on flexor surfaces of extremities, glans penis, & oral mucosa

Question 39

Diagnose

Answer 39

lichen planus

Question 40

What is the first indication that a patient has Crohn's disease?

Answer 40

oral manifestation [oral ulcers are deeper than aphthous ulcers and are typically persistent]

Question 41

Diagnose this lesion and describe it

Answer 41

***ameloblastoma*** * cystic, slow growing * locally invasive [indolent course] * rarely malignant/metastatic * causes severe abnormalities of face and jaw

Question 42

Biopsy of a patient complaining of a slow growing cyst on his jaw. What is the diagnosis and describe its histology?

Answer 42

***ameloblastoma*** 1. Composed of nests, strands or cords of ameloblastic epithelium separated by small amounts fibroconnective tissue stroma 2. cyst arises from odontogenic epithelium

Question 43

What factors are associated with this lesion?

Answer 43

1. trauma 2. allergies 3. exposure to ultraviolet light 4. extremes of temperature 5. upper- respiratory tract infections 6. pregnancy 7. menstruation 8. immunosuppression

Question 44

Primary infection, latency and secondary infection of this disease

Answer 44

* Primary infection: 2-4 yrs [most asymptomatic] via saliva * manifests as acute herpetic gingivostomatitis in 10% to 20% with abrupt onset of vesicles and ulcerations * Latency in sensory nerve ganglion cells * Secondary infection: * groups of small vesicle on lips, nasal orifices, buccal mucosa, gingiva, and hard palate

Question 45

describe the following:

Answer 45

* Molding * Multinucleated giant cells * Nuclear inclusions (Cowdry A) * Ground glass (Cowdry B)

Question 46

Describe the microscopic feature of this lesion

Answer 46

* Ballooned cells with large eosinophilic intranuclear inclusions * Adjacent cells commonly fuse to form large multinucleated polykaryons

Question 47

Diagnose and describe this lesion

Answer 47

* Thrush [CANDIDIASIS] * superficial, curdlike, *gray to white inflammatory membrane* composed of matted organisms enmeshed in a fibrinosuppurative exudate that can be *readily scraped off* to reveal an underlying erythematous base. * Superfical in mildly compromised * spreads in severely immunocompromised patients

Question 48

Diagnose

Answer 48

Candidiasis [pseudohyphae with no septations, resembles ginger]

Question 49

Diagnose and describe this lesion

Answer 49

Fibromas * submucosal nodular fibrous tissue masses that are formed when chronic irritation results in reactive connective tissue hyperplasia * They occur most often on thebuccal mucosa along the bite line.

Question 50

Diagnose this oral lesion

Answer 50

Fibromas

Question 51

What is the treatment of this condition?

Answer 51

* complete surgical excision and removal of source of irritation [Fibromas]

Question 52

What is the treatment of this condition?

Answer 52

* complete surgical excision and removal of source of irritation [Pyogenic fibromas]

Question 53

What would happen if this condition is left untreated?

Answer 53

1. may regress 2. mature into dense fibrous mass 3. develop into peripheral ossifying fibromas

Question 54

What gives this lesion its appearance?

Answer 54

richly vascular and typically ulcerated, which gives them a red to purple color

Question 55

Which of the following lesion has a greater risk for developing into squamous cell carcinoma?

Answer 55

the one of the right [Erythroplakia]

Question 56

Describe the gross appearance of this lesion

Answer 56

White plaque that cannot be scraped off and cannot be characterized as any other disease [Leukoplakia]

Question 57

Describe the gross morphology of this lesion

Answer 57

Red velvety that is usually level with the surrounding mucosa or slightly depressed

Question 58

Epidemiology of this lesion

Answer 58

1. 40-70 yrs. 2. 2:1 male to female 3. associated with tobacoo use 4. much greater risk for malignant transformation than leukoplakia

Question 59

Epidemiology of this lesion

Answer 59

* ~3% of the world’s population has leukoplakic lesions, of which 5% to 25% are dsyplastic and at risk of SCC

Question 60

Examination of a smoker shows the following. What is the pathophysiology of this condition?

Answer 60

1. Exposure to carcinogens * Exposure to tobacco shows mutation in TP53 + RAS 2. Infection with high risk variants of HPV * Tend to occur in the tonsillar crypts or the base of the tongue and harbor oncogenic “high-risk” subtypes [HPV-16] * Often overexpress p16 * better prognosis than HPV -ve tumors

Question 61

What are the clinical forms of this condition?

Answer 61

1. Pseudomembranous 2. Erythematous 3. Hyperplastic

Question 62

What is the gross appearance of this lesion?

Answer 62

[SCC] Early lesion * raised, firm, pearly plaques or roughened, verrucous mucosal thickenings Late lesion * ulcerated, protruding masses that have irregular and indurated or rolled borders Both maybe superimposed on leukoplakia or erythroplakia