90 Questions
What is the most common bacterial skin infection in children?
Impetigo contagiosa
What are the predisposing factors for impetigo contagiosa?
Minor skin trauma
In which population is streptococcus generally found in cases of impetigo contagiosa?
Pediatric population
What is the etiology of pyoderma in case of immunocompromising situations?
Saprofitic cocci
What can easily inoculate to the surrounding tissues in cases of impetigo contagiosa?
Bacterial infection
Which bacteria are the causes of impetigo contagiosa?
Streptococcus / staphylococcus
Which topical antibiotic is recommended as the first-line treatment for nonbullous type bacterial infections of the oral mucosa?
Mupirocin
What is the primary causative agent of erysipelas, a type of chronic pyoderma affecting the face and lower extremities?
S. pyogenes
Which oral antibiotics are recommended as the first-line treatment for erysipelas?
Penicillin or erythromycin
What is the recommended treatment for necrotizing ulcerative stomatitis, a rare complication of necrotizing ulcerative gingivitis?
Systemic metronidazole and mouthwashes with oxygen-producing elements
What is the debatable infectious oral disease caused by β-hemolytic Streptococcus, commonly affecting the gingiva and tongue?
Streptococcus gingivostomatitis
What are the clinical features of nonbullous type bacterial infections of the oral mucosa?
Red macules, vesicles, pustules, and superficial erosions with 'honey-colored' yellow crust
Which oral mucosa infection is mainly endemic in Africa, Asia, South America, and Japan?
Leprosy
Which oral mucosal infection is primarily associated with spirochete and anaerobic infection?
Necrotizing ulcerative gingivitis
What are the clinical features of actinomycosis?
Painless inflammatory swelling and discharge of sulfur granules
Which medication is the treatment of choice for noma?
High-dose penicillin IV and metronidazole
How is the diagnosis of leprosy confirmed?
Histologic examination
What is the primary cause of gonococcal stomatitis?
Neisseria gonorrhoeae
What is the treatment for actinomycosis?
Penicillin G, penicillin V, and surgical removal of infected tissues
Which oral mucosal infection may be asymptomatic?
Gonococcal stomatitis
What are the oral manifestations of syphilis?
Red nodules progressing to necrosis and ulcerations
What laboratory tests are typically required for confirmation of diagnosis of oral mucosal infections?
Gram staining and culture
Which infection affects the salivary glands, jaw bone, and skin of the neck and face?
Actinomycosis
Which antibiotic is NOT mentioned as a treatment for oral mucosal infections?
Ciprofloxacin
Which diagnostic tool is most specific for diagnosing primary syphilis?
Dark-field microscopic examination
What are the generalized mucocutaneous manifestations of secondary syphilis?
Pruritus, nail involvement, and various skin lesions
What are the oral mucosa manifestations of secondary syphilis?
Macular syphilides, mucous patches, papular syphilides, and condylomata lata
What are macular syphilides and mucous patches in the context of oral manifestations of secondary syphilis?
Red oval spots and painless papules with erosions or superficial ulcers
Which test is not a diagnostic tool for secondary syphilis?
Dark-field microscopic examination
What is an oral manifestation related to late syphilis?
Interstitial glossitis
What is the treatment of choice for oral mucosal candidiasis?
Systemic -azoles
What is the most frequent cause of candidiasis?
Candida albicans
In healthy individuals without local predisposing factors, what is the clinical manifestation of C. albicans?
No clinical manifestations
Which condition is NOT listed as a local predisposing factor for candidiasis?
HIV infection
Which systemic condition is NOT listed as a predisposing factor for candidiasis?
Chronic use of local antibiotics
Which age group is particularly susceptible to candidiasis?
Newborns and infants
What is the fungus responsible for the majority of oral mucosal candidiasis?
Candida albicans
Which fungal infection is characterized by weight loss, fever, dyspnea, and a painful irregular ulcer with a granulomatous surface in the oral cavity?
Paracoccidioidomycosis
Which fungal infection is endemic in certain areas of North America and presents as solitary or multiple ulcers with a slightly verrucous and irregular surface in the oral cavity?
Blastomycosis
Which fungal infection is an opportunistic infection primarily affecting the central nervous system and rarely affecting the oral mucosa with chronic ulceration that can be indurated and tender on palpation?
Cryptococcosis
Which fungal infection is transmitted by spore inhalation and can lead to perforation of the hard palate in severe cases if left untreated?
Paracoccidioidomycosis
Which fungal infection is usually transmitted through airborne fungal spores and can involve the oral mucosa, skin, genitourinary tract, and other organs in disseminated disease?
Cryptococcosis
Which fungal infection is caused by a dimorphic fungus that is endemic in Central and South America?
Paracoccidioidomycosis
Which fungal infection presents as papules and nodules that proceed to ulcerate in approximately 15% of patients and rarely affects the oral mucosa with chronic ulceration?
Cryptococcosis
Which fungal infection primarily affects the lungs and can lead to oral lesions characterized by a slightly verrucous and irregular surface with thin borders that mimic squamous cell carcinoma?
Blastomycosis
Which fungal infection is caused by an opportunistic pathogen and rarely affects the oral mucosa, usually involving the central nervous system, bone, skin, and other organs?
Cryptococcosis
Which form of candidiasis is characterized by deep infiltration of oral tissues and may predispose to squamous cell carcinoma?
Nodular or plaque-like candidiasis
Which group of syndromes is characterized by chronic lesions of the skin, nails, and mucosae?
Chronic mucocutaneous candidiasis
What is the most common form of candidiasis, characterized by creamy white or whitish-yellow plaques that can be easily detached?
Pseudomembranous candidiasis
Which oral mucosal condition is prevalent in HIV-infected individuals and those receiving immunosuppressive agents?
Erythematous candidiasis
What is a rare chronic form of candidiasis affecting people with a high-arched palate who do not wear dentures?
Papillary hyperplasia of the palate
What is the diagnostic tool that may be required for confirmation of oral mucosal candidiasis?
Swab culture examination
What is the topical drug of choice for the treatment of oral mucosal candidiasis?
Nystatin
Which fungal infection is primarily associated with poorly controlled diabetes as the most common predisposing condition?
Mucormycosis
What is the most common clinical form of mucormycosis characterized by low-grade fever, headache, malaise, and progressive lethargy?
Rhino-orbitocerebral form
What is the most common form of aspergillosis characterized by fever, dyspnea, dry cough, and irregular oral ulcerations?
Invasive pulmonary aspergillosis
Which fungal infection is caused by Histoplasma capsulatum and is endemic in warm and humid climates?
Histoplasmosis
What is the treatment of choice for mucormycosis?
Liposomal amphotericin B and surgical debridement
How is aspergillosis transmitted?
Through inhalation of spores
What is the characteristic oral lesion of histoplasmosis?
Irregular and indurated painful ulceration with a verrucous surface
What is the main clinical feature of primary herpetic gingivostomatitis?
High fever and bilateral cervical lymphadenopathy
What is the primary cause of primary herpetic gingivostomatitis?
Herpes simplex virus, type 1 (HSV-1)
How is HSV-1 transmitted?
Through direct contact with saliva or other secretions
What are the systemic and local symptoms of primary herpetic gingivostomatitis?
High fever, headache, malaise, loss of appetite, and pain in the mouth
What is the age group mainly affected by primary herpetic gingivostomatitis?
Children (1–6 years), adolescents, and rarely adults
What is the course of pathogenesis for herpetic infections?
Primary infection—latent phase—reactivation
Which oral lesion is characterized by papillomatous projections of hyperplastic and hyperkeratotic squamous epithelium supported by a thin fibrous core?
Papilloma
Which oral mucosal condition may present as small, painless, exophytic lesions with a “cauliflower-like” surface and white or pink-white color?
Condyloma accuminatum
Which oral lesion is indicative of HIV infection and may worsen during combination antiretroviral therapy (cART), according to the text?
Oral hairy leukoplakia (OHL)
What is the treatment of choice for the oral lesions caused by viral infections?
Conservative surgical excision
What are the alarming oral clinical manifestations suggestive of HIV infection, according to the text?
Both A and B
Which age group is particularly susceptible to various oral lesions that may occur at any stage of HIV/AIDS infection?
All age groups equally
Which of the following is a characteristic of herpetic gingivostomatitis?
May cause keratoconjunctivitis and meningitis
What is the first-line therapy for herpetic gingivostomatitis?
Antiviral agents like acyclovir
What is the characteristic presentation of herpes labialis?
Recurrences triggered by sun exposure
What are the clinical features of herpangina?
Sudden fever and headache
What is the differential diagnosis for herpetic gingivostomatitis?
Hand-foot-and-mouth disease
What is the treatment for herpes labialis?
Topical application of antiviral creams or ointments
Which viral infection is more common in children and young adults, aged 15 to 25 years?
Infectious Mononucleosis
Which viral infection is caused by the reactivation of herpes virus type 3 (VZV)?
Herpes Zoster
Which viral infection typically presents with small vesicles on the oral mucosa and skin lesions on fingers, toes, palms, and soles?
Hand-Foot-and-Mouth Disease
Which viral infection is usually self-limited and resolves spontaneously without treatment?
Hand-Foot-and-Mouth Disease
Which viral infection is characterized by low-grade fever, sore throat, lymphadenopathy, and hepatomegaly?
Infectious Mononucleosis
Which viral infection's oral manifestations are almost identical to the cutaneous lesions?
Herpes Zoster
Which viral infection presents with multiple small projections and affects both sexes equally?
Papilloma
What is the preferred treatment for condyloma acuminatum?
Conservative surgical excision
Which viral infection is commonly observed in American Indians, Eskimos, and South Africans?
Focal epithelial hyperplasia (Morbus Heck)
What characterizes verruciform xanthoma hyperplasia of epithelial layers on histologic examination?
Hyperplasia of epithelial layers
What is the causative agent of focal epithelial hyperplasia?
HPV types 13 and 32
What is the characteristic surface appearance of condyloma acuminatum?
Warty
Study Notes
Syphilis: Clinical Stages and Oral Manifestations
- Syphilis is classified into early (lasting <1 year), latent (early stage lasting ≤1 year, late stage lasting >1 year), and late (tertiary) stages.
- The primary lesion of acquired syphilis is the painless chancre, which may occur genitally or extragenitally and heals spontaneously within 3 to 8 weeks.
- Dark-field microscopic identification of T. pallidum in smears from the chancre is the most specific test for diagnosing primary syphilis.
- Secondary syphilis signs and symptoms, which appear 6 to 8 weeks after the chancre, include constitutional symptoms and mucocutaneous manifestations.
- Generalized mucocutaneous manifestations of secondary syphilis include pruritus, nail involvement, and various skin lesions.
- Oral mucosa manifestations of secondary syphilis include macular syphilides, mucous patches, papular syphilides, and condylomata lata.
- Macular syphilides are red oval spots, while mucous patches are painless papules with erosions or superficial ulcers.
- Papular syphilides are rare in the oral mucosa and may form slightly raised, firm nodules with a tendency to ulcerate.
- Condylomata lata, which rarely appear in the oral cavity, are elevated, vegetating, or papillomatous lesions, usually found at the corners of the mouth and palate.
- Diagnostic tools for secondary syphilis include dark-field microscopic examination, immunofluorescence, and serologic tests (VDRL, RPR, FTA-ABS, TPI, TPHA).
- The differential diagnosis of secondary syphilis includes candidiasis, lichen planus, leukoplakia, aphthous ulcers, herpetic stomatitis, erythema multiforme, and trauma.
- Oral manifestations of specific infections related to late syphilis include interstitial glossitis.
Fungal Infections: Mucormycosis, Aspergillosis, and Histoplasmosis
- Mucormycosis primarily affects debilitated individuals, with poorly controlled diabetes as the most common predisposing condition.
- The disease has five major clinical forms, with the rhino-orbitocerebral form being the most common, characterized by low-grade fever, headache, malaise, and progressive lethargy.
- Diagnosis of mucormycosis involves histopathologic examination revealing broad ribbon-like Rhizopus hyphae within necrotic tissues, and treatment includes liposomal amphotericin B and surgical debridement.
- Aspergillosis is caused by Aspergillus, with the most common form being invasive pulmonary aspergillosis, characterized by fever, dyspnea, dry cough, and irregular oral ulcerations.
- The disease is transmitted through inhalation of spores and affects individuals with primary and secondary immunodeficiencies, organ transplantation, and high-dose steroids.
- Histopathologic examination of aspergillosis lesions demonstrates septate hyphae with 45-degree branching, and treatment involves voriconazole and posaconazole as the drugs of choice.
- Histoplasmosis is caused by Histoplasma capsulatum and is endemic in warm and humid climates, with oral lesions occurring in approximately 35 to 45% of cases.
- The disease is transmitted through inhalation of fungus spores and is endemic in specific areas like the United States, Africa, and Asia.
- Oral lesions of histoplasmosis are characterized by irregular and indurated painful ulceration with a verrucous surface.
- Differential diagnosis for mucormycosis includes nasal NK-T non-Hodgkin’s lymphoma, Wegener’s granulomatosis, and other systemic mycoses that affect the mouth.
- Differential diagnosis for aspergillosis includes mucormycosis, nasal NK-T non-Hodgkin’s lymphoma, Wegener’s granulomatosis, and other systemic mycoses that affect the mouth.
- Differential diagnosis for histoplasmosis includes malignancies, tuberculosis, and other systemic mycoses that affect the mouth.
Viral Infections in Oral Pathology
- Herpes zoster, secondary herpetic stomatitis, varicella, erythema multiforme, and herpangina are differential diagnoses for viral infections in oral pathology.
- Cytologic examination confirms virally modified epithelial cells with acantholysis and formation of Tzanck cells in herpes zoster.
- Antiviral therapy within 3 to 4 days from symptom onset is effective for herpes zoster, and prednisolone may alleviate acute symptoms and reduce the risk for postherpetic neuralgia.
- Papilloma, a benign tumor of the surface epithelium, is often caused by human papillomavirus (HPV) types 6 and 11 and presents with multiple small projections.
- Papilloma affects both sexes equally, usually between the ages of 30 and 50, and is commonly found on the tongue and soft palate.
- Verruciform xanthoma hyperplasia of epithelial layers characterizes papilloma on histologic examination.
- Focal epithelial hyperplasia (Morbus Heck) is caused by HPV types 13 and 32 and is commonly observed in American Indians, Eskimos, and South Africans.
- Focal epithelial hyperplasia presents as multiple, slightly elevated, painless nodules and can also appear in adults.
- Lesions of focal epithelial hyperplasia may spontaneously reverse after a few months to 2 years, and conservative surgical excision or laser therapy can be suggested for esthetic concerns.
- Condyloma acuminatum, caused by HPV types 6 or 11, is a common, sexually transmitted disease presenting as painless, exophytic tumors with a "cauliflower-like" surface.
- Condyloma acuminatum is characterized by parakeratosis, acanthosis, and elongation of rete ridges on histologic examination, with the preferred treatment being conservative surgical excision or electrosurgery.
- Verruca vulgaris, associated with HPV types 1, 2, and 4, is transmitted intraorally through self-inoculation and is rarely observed in the mouth.
Test your knowledge of syphilis clinical stages and oral manifestations with this informative quiz. Learn about the primary lesion, secondary signs, mucocutaneous manifestations, diagnostic tools, and differential diagnosis of syphilis, including specific oral mucosa manifestations.
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