Important solved questions-NBDE part 2-4

Recurrent Aphthous Stomatitis:
aphtous ulcers in non keratinized tissue – herpes in keratinized tissue
aphthous stomatitis: recurrent discrete areas of ulceration that are almost always painful. Occurs
on freely movable mucosa that does not overlie bone,Aphthous can be differentiated since it
usually does not occur over bone, does not form vesicles and is not accompanied by fever or
gingivitis

QUESTION: Pt has occasional sores on mucolabial fold on mandibular arch that healed without
scarring:
minor aphthous

QUESTION: Ulcer that appears often on buccal vestibule that goes away without scarring after
a week or
so? Minor Apthous ulcer.QUESTION: Ulcer healing with scar tissue: major apthous ulcers AIDS

QUESTION: A chancre due to Syphilis mostly resembles: herpes ulcers

QUESTION: History of lesions that go away after 1 week – recurrent aphthous ulcers

QUESTION: What don’t u treat aphthous ulcers with – acyclovir
Benign Mucous Membrane Pemphigoid (cicatricial):
Pemphigoid = D = DEEPER (subepithelial separation) than pemphigus S = SURFACE
(epithelial
separation)
70
Know Pemphigoid–**autoimmune disorder where antibodies attack the fibrous attachment of
the skin and membrane epithelium. Blisters and vesicles
Histology: subepidermal ,no acantolysis

QUESTION: Pemphigoid – separation of basement membrane

QUESTION: Subepithelial separation on immunofluorescence indicates? benign mucous
membrane pemphigoid………….subepidermal / subepithelial -pemphigoid
Pemphigus vulgaris………..suprabasilar vesicle, acantholysis

QUESTION: Another name for chronic desquamative gingivitis? Cicatricial pemphigoid

QUESTION: The oral lesions of benign mucous membrane pemphigoid most
commonly present as desquamative gingivitis
Disease with Desquamative gingivitis: lichen planus, mucous membrane pemphigoid (95%) and
pemphigus
A band of red atrophic or eroded mucosa affecting the attached gingiva is known as dequamative
gingivitis. Unlike plaque-induced inflammation it is a dusky red colour and extends beyond the
marginal gingiva, often to the full width of the attached gingiva and sometimes onto the alveolar
mucosa.

QUESTION: Desquamative gingivitis is associated with which 2 conditions. Lichen planus and
Pemphigoid
Pemphigus vulgaris is MUCH LESS SEVERE and blistering of skin caused by binding of
antibodies to the surface of the cells of the outer skin
Clinical features: ulcerations & erosions covered by blood tinged exudates

QUESTION:Sloughing of gingiva epithelium in max and mand arches:
A) pemphigus
B) pemphigoidC) both

QUESTION: Child formed blisters with minor lip irritation? Epidermolysis bullosa

QUESTION: Which pemphigoid like lesion most often in infants?
EPIDERMOLYSIS BULLOSA : it is characterized by fluid filled blisters on the skin especially
on hands and feet due to friction.skin thickenening on the palms and soles of the feet.internal
blistering

QUESTION: Young child/infant exhibits ulcerations of mouth: epidermalysis bulosa
Condyloma Acuminatum:

QUESTION: Condyloma accuminatum (genital wart) is caused by which virus? HPV 6 &11

QUESTION: Which of the following does not have cauliflower like , pebbly appearance?
Verrucous
carcinoma, fibroma , condyloma accuminata, papilloma.
Ans fibroma…..A FIBROMA IS A BENING NEOPLASM OF CONNECTIVE TISSUE
ORIGIN
Candidiasis:
Candida forms – ulcer, Erythema, white hyperplastic, white/curd

QUESTION: Systemic antifungal in HIV patient?? Fluconazole

QUESTION: Hiv patient with oropharyngeal candidiasis, what would u prescribefluconzole ????

QUESTION: Patient with HIV has candidiasis- bec it is HIV related, increased CD 4… ( I wrote
increase
CD4…?)

QUESTION: which oral medication would you give to tx vaginal candidiasis? Nystatin,
griseofulvin,
monistat, Diflucan (fluconazole)

QUESTION: If pt undergoes radiotherapy for cancer, the most common oral infection that
necessitates
drug tx in this stage is? 1. Candida albicans (answer)

QUESTION: Candidasis in cancer patients due to- chemotherapy, radionecrosis

QUESTION: Inhaled methacholine (steroid) produce oral candidiasis

QUESTION: Pt has multiple white patches that can be scraped off

candidiasis

QUESTION: Oral cytology smears are MOST appropriately used for the diagnosis of which
of the following? Pseudomembraneous candidiasis

QUESTION: What oral manifestation is seen in children with HIV? Candidiasis #1

QUESTION: Patient is 4yrs old on lots of AB what is most likely? Candidiasis

QUESTION: Candida- can wipe away: Nysatatin

QUESTION: systemic med for candida: amphotericin B
S

QUESTION: broad spectrum antibiotics :increase superinfection (infxn by candidiasis) and resistance.

QUESTION: Which is associated w/ burning mouth? Candida

QUESTION: Lesion in the middle of tongue also pt had it on palate before and pt is healthy?
Karposi, candidiasis, Syphilis

QUESTION: Rhomboid tongue thought to be- a type of candidiasis

QUESTION: Median rhomboid glossitis—***smooth red area of tongue that lacks the papillae

QUESTION: Healthy 36 year old, red patch on palate, redness in middle of tongue:
-kaposi sarcoma,
-syphilis
-median rhomboid glossitis
-gonorrhea
Primary Herpes:
Gingivostomatitis Herpetica: initial presentation during the first (“primary”) herpes
simplex infection. of greater severity than herpes labialis (cold sores) which is often
the subsequent presentations. is the most common viral infection of the
mouth,affects both the free and attached mucosa. Tx Acyclovir, valacyclovir, Penciclovir
Famciclovir.

QUESTION: 85% of people have herpes
a. 65-90% worldwide; 80-85% Usa( I hav no idea)

QUESTION: Age of primary infection of herpes? 2 yo, 4 yo, 6 yo, 8 yo, 10 yo (added info below
From oral path book under viral infections; “acute herpetic gingivostomatitis arise between 6
months and 5 years, with peak prevalence btwn 2-3 years of age. Development before 6 months is
rare due to protection of maternal anti-HSV antibodies.

QUESTION: Young person w/ fever & vesicles: FEVER = PRIMARY herpes stomatitis

QUESTION: Primary herpatic gingivostomatitis- fever, ulcer in mouth. No symptoms

QUESTION: Primary herpatic gingivostomatitis- child 2 yrs , fever, not ant to eat

QUESTION: After orthodontic tx, pt with no other systemic disease develop high fever?
due to canker sores by newly placed brackets.

QUESTION: ways to treat kid w/ herpetic gingivostomatitis EXCEPT
a. antibiotics
b. give numbing anesthetic before eating
c. have pt rest and drink lots of water
Recurrent Herpes Simplex:
aphtous ulcers in non keratinized tissue – herpes in keratinized tissue

QUESTION: Herpes can be diagnosed by exfoliative cytology. A characteristic
multinucleated cell appears in the smear of herpes infections.

QUESTION: Recurrent intraoral herpes occurs almost exclusively on mucosa overlying bone.
The hard palate is the most common site, alveolar mucosa

QUESTION: 2ndary herpes ? lip, gingival, and palate pg 106, table 4-1

QUESTION: Herpes simplex is ASSOCIATED WITH Bell’s palsy& TRIGEMINAL
NEURALGIA

QUESTION: Herpetic withlow? Herpes on finger
DRUG OF CHOICE:
acyclovir: herpes I, II, VZV,EBV
ganciclovir (IV): CMV or (valancyclovir – oral)
Primary HSV: PALLATIVE
recurrent herpes medication: docosanol (abreva), acyclovir (zovirax)Know drugs that are used for Herpes: Acyclovir, valtrex (valacyclovir), docosanol (abreva),
andPENCICLOVIR

QUESTION: Acyclovir given for herpetic lesions. Also, phosphorylated and activated in infected
viral cells.

QUESTION: herpes, zoster – Valacyclovir treats herpes labialis

QUESTION: Patient gets recurrent herpetic lesions very often with gingivostomatitis. What should be done?
Acyclovir.
Palliative trt

QUESTION: Hiv pt with oral herpes, what would u prescribe- vir

QUESTION: Tx for herpatic gingivostomatitis?
• palliative tx**
• acyclovir
• systemic antibiotic
• steroids

QUESTION: best med for herpes, CMV…acyclovir
.
QUESTION: Valcyclovir (Valtrex): Tx for herpes simplex/herpes zoster

QUESTION: Tx for herpes simplex and herpes zoster : Valtrax

QUESTION: Which most closely mimics dental pain: herpes zoster

CORTICOSTEROIDS ARE CONTRAINDICATED IN PATIENTS WITH HERPES SIMPLEX
INFECTIONS

QUESTION: Patient comes with recurrent herpetic stomatitis on the lips and history shows no
signs
of primary herpetic gingivostomatitis. Why? Most primary infections are subclinic

QUESTION: pt presents at 3 days with secondary herpes lesion? What the treatment of choice?
Antiviral?
Palative treatment****
Acyclovir was an answer choice (but acyclovir works best before you get the lesion)QUESTION: Herpetic gingivostomatitis – within 3 days of onset: treat with Acyclovir 15mg/kg
5 times
per day for 7 days
All patients: palliative care: plaque removal, systemic NSAIDS, and topical anesthetics
Contagious when vesicles are present

QUESTION: Primary herpretic stomatitis? Reactivation of the primary can cause recurrent
herpes
Infection

QUESTION: Which dz is caused by the virus that causes acute herpetic gingivostomatitis?
A: herpes simplex 1

QUESTION: Herpes lesion intra orally how do u treat? Palliative, acyclovir?? *Tx is supportive
—topical
before eating, analgesics, maintain fluid/electrolyte balance, anti-viral agents. DO NOT GIVE
CORTICOSTEROIDS.

QUESTION: acyclovir inhibits mrna. How does it have selective toxicity MOA? Only
phosphorylated in infected cells and inhibits viral mRNA…does not work on dna

QUESTION: Acyclovir-inhib mRNA?-phosphorylated-. nucleoside analogues–can’t make RNA
The mechanisms of antiviral action of acyclovir are well known (Figure 40-9). The nucleoside
analogue is phosphorylated to form acyclovir monophosphate by herpesvirus-encoded
thymidine kinase and phosphorylated further by other enzymes to acyclovir diphosphate and
triphosphate. Acyclovir triphosphate acts to inhibit viral DNA polymerase and to terminate
elongation of the viral DNA chain as spurious nucleotide is incorporated into DNA. In the
noninfected host cell, phosphorylation of acyclovir occurs to a limited extent. Acyclovir
triphosphate inhibits HSV DNA polymerase 10 to 30 times more effectively than it does
mammalian cell DNA polymerase.

QUESTION: how is Acyclovir selective toxicity mechanism of action?
1. only phosphorylated in infected cells and inhibits viral mRNA
2. does NOT work on DNA

QUESTION: Post herpetic neuralgia cause by: (VZV)herpes zoster,

QUESTION: What does histoplasmosis oral lesion look like? NONHEALING ULCER
TUBERCULOSIS

QUESTION: Same patient as #49, has upper denture, when he removes it, there is unilateral
lesion on the
palate. What could it be? – Herpes (other choices were more serious pathological lesions).

QUESTION: Pic with half the tongue (left side) that looks like herpes lesion and other nothing
on it- Iwrote zoster

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