Podcast
Questions and Answers
What is the primary cause of the pigmentation seen in Addison's disease?
What is the primary cause of the pigmentation seen in Addison's disease?
- Excessive secretion of adrenocorticotropic hormone (ACTH) (correct)
- Increased blood pressure
- Decreased melanin production
- Deficiency of melanocyte-stimulating hormone (MSH)
Which of the following is not a typical clinical feature of Addison's disease?
Which of the following is not a typical clinical feature of Addison's disease?
- Fatigue and weakness
- Low blood pressure
- Craving for sweets (correct)
- Gastrointestinal disturbances
In which circumstance is it necessary to adjust the dosage of hydrocortisone for a patient with Addison’s disease?
In which circumstance is it necessary to adjust the dosage of hydrocortisone for a patient with Addison’s disease?
- When experiencing weight gain
- During regular exercise
- When undergoing surgery (correct)
- During sleep
What is the risk associated with failure to provide sufficient steroid in Addison's disease?
What is the risk associated with failure to provide sufficient steroid in Addison's disease?
What type of adrenal destruction is least likely to cause adrenal insufficiency?
What type of adrenal destruction is least likely to cause adrenal insufficiency?
Which laboratory finding is indicative of Addison's disease?
Which laboratory finding is indicative of Addison's disease?
Which symptom is commonly seen in Addison's disease due to a lack of aldosterone?
Which symptom is commonly seen in Addison's disease due to a lack of aldosterone?
What is the appearance of skin pigmentation in Addison's disease often compared to?
What is the appearance of skin pigmentation in Addison's disease often compared to?
What is typically the first-line treatment for chronic oral fungal infections?
What is typically the first-line treatment for chronic oral fungal infections?
Which patient group is more likely to have complications from oral tuberculosis?
Which patient group is more likely to have complications from oral tuberculosis?
What might indicate a potentially malignant lesion after antifungal treatment?
What might indicate a potentially malignant lesion after antifungal treatment?
What symptom is NOT typically associated with pulmonary tuberculosis?
What symptom is NOT typically associated with pulmonary tuberculosis?
What characteristic describes the ulcers typically seen in oral tuberculosis?
What characteristic describes the ulcers typically seen in oral tuberculosis?
Which of the following is true regarding oral tuberculosis?
Which of the following is true regarding oral tuberculosis?
Which systemic antifungal may be needed after using miconazole gel?
Which systemic antifungal may be needed after using miconazole gel?
What is an uncommon symptom of oral tuberculosis?
What is an uncommon symptom of oral tuberculosis?
What is a critical action required when assessing a patient suspected of having lichenoid drug reactions?
What is a critical action required when assessing a patient suspected of having lichenoid drug reactions?
Which drug class is commonly implicated in oral lichenoid drug eruptions?
Which drug class is commonly implicated in oral lichenoid drug eruptions?
How do topical lichenoid reactions typically manifest?
How do topical lichenoid reactions typically manifest?
What is the treatment approach for managing lichenoid reactions?
What is the treatment approach for managing lichenoid reactions?
Which of the following descriptions best characterizes the lesions caused by topical lichenoid reactions?
Which of the following descriptions best characterizes the lesions caused by topical lichenoid reactions?
What potential mechanism could cause drug-induced lichenoid reactions?
What potential mechanism could cause drug-induced lichenoid reactions?
Which type of restorative material is most commonly associated with topical lichenoid reactions?
Which type of restorative material is most commonly associated with topical lichenoid reactions?
In patients with lichenoid reactions, when is treatment generally not required?
In patients with lichenoid reactions, when is treatment generally not required?
Which of the following features is NOT typically associated with Oral Crohn’s disease?
Which of the following features is NOT typically associated with Oral Crohn’s disease?
Which subtype of lichen planus is most commonly associated with erosive lesions?
Which subtype of lichen planus is most commonly associated with erosive lesions?
What condition is closely associated with ulcerative colitis due to its similar oral manifestations?
What condition is closely associated with ulcerative colitis due to its similar oral manifestations?
What is the main cause of malabsorption in coeliac disease?
What is the main cause of malabsorption in coeliac disease?
Where are skin lesions from cutaneous lichen planus most frequently found?
Where are skin lesions from cutaneous lichen planus most frequently found?
What potential deficiency can result from iron and folate malabsorption due to coeliac disease?
What potential deficiency can result from iron and folate malabsorption due to coeliac disease?
What characteristic feature is noted on papules in lichen planus?
What characteristic feature is noted on papules in lichen planus?
Which histological feature is predominant in the epithelium of lichen planus?
Which histological feature is predominant in the epithelium of lichen planus?
Which of the following is a symptom associated with oral manifestations of crohn’s disease?
Which of the following is a symptom associated with oral manifestations of crohn’s disease?
What is the term for lichen planus-like lesions triggered by a drug?
What is the term for lichen planus-like lesions triggered by a drug?
Ulcerative colitis primarily affects which part of the gastrointestinal tract?
Ulcerative colitis primarily affects which part of the gastrointestinal tract?
What is a common histological finding in atrophic lesions of lichen planus?
What is a common histological finding in atrophic lesions of lichen planus?
Which condition is characterized by a compact, band-like infiltrate hugging the epithelial-connective tissue interface?
Which condition is characterized by a compact, band-like infiltrate hugging the epithelial-connective tissue interface?
In which regions of the body is cutaneous lichen planus least likely to appear?
In which regions of the body is cutaneous lichen planus least likely to appear?
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Study Notes
Addison's Disease
- Autoimmune disorder characterized by organ-specific circulating autoantibodies.
- Rare cases may be caused by tuberculosis or fungal infections, often linked to HIV.
- Adrenal insufficiency disrupts electrolyte and fluid balance, leading to severe clinical consequences.
- Compensatory overproduction of adrenocorticotropic hormone (ACTH) leads to skin and mucosal pigmentation.
- Initial pigmentation often appears on gingivae, buccal mucosa, and lips, resembling a suntan; can range from brown to nearly black.
- Long-term management typically involves oral hydrocortisone, with dosage adjustments needed during stress or illness.
- Insufficient steroid treatment may precipitate an Addisonian crisis, presenting severe health risks.
Clinical Features of Addison's Disease
- Symptoms include lassitude, anorexia, weakness, fatigue, and craving for salt due to low aldosterone levels.
- Gastrointestinal issues such as diarrhea, nausea, and vomiting may occur alongside significant weight loss and low blood pressure.
- Increased risk for hypotensive crises and potential association with chronic mucocutaneous candidiasis in different syndromes.
Diagnosis of Addison's Disease
- Diagnosed by monitoring low blood pressure and elevated ACTH levels.
Management of Addison's Disease
- After confirming diagnosis through histology, antifungal treatment for secondary infections may be necessary, though difficult to eradicate completely.
- Miconazole gel is effective, sometimes requiring systemic options like fluconazole.
Oral Tuberculosis
- Oral tuberculosis is uncommon and usually associated with active pulmonary disease.
- Typically affects elderly men with chronic undiagnosed pulmonary infections, showing symptoms like chest pain and weight loss.
- Characterized by painless ulcers on the mid dorsum of the tongue with distinct angular or stellate shapes.
Oral Crohn’s Disease
- Presents with soft or tense swelling of lips, cobblestone buccal mucosa, erythematous gingivae, and painful linear mucosal ulcers.
- Glossitis may arise from deficiencies in iron, folate, or vitamin B12 due to malabsorption.
Ulcerative Colitis
- Chronic inflammation of the large intestine leading to ulceration, with oral manifestation linked to pyostomatitis vegetans and related anemia.
Coeliac Disease
- Permanent intolerance to gliadin, resulting in inflammation of the small intestine and villous atrophy.
- Malabsorption can lead to deficiencies, particularly iron and folic acid; can present various oral lichen planus types.
Lichen Planus
- Cutaneous lichen planus appears as dusky pink papules with Wickham's striae; typically occurs in flexor regions and other sites.
- Histological features include hyperkeratosis, lymphocytic infiltrate, and significant basal cell destruction.
Lichenoid Reactions
- Induced by various triggers, including drugs, making clinical differentiation from lichen planus challenging.
- Commonly involved drug categories include NSAIDs, ACE inhibitors, and antimalarials, emphasizing the need for thorough patient drug histories.
Topical Lichenoid Reactions
- Can be triggered by restorative materials like amalgam, localized to the areas in contact with materials.
- Clinical features often mimic lichen planus or lupus erythematosus.
Management of Lichenoid Reactions
- Symptomatic treatments aim to manage flare-ups; many asymptomatic lesions require no intervention.
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