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## American Academy of Oral Medicine Mock Academic Affiliate Fellowship Examination 2019 Summary:

Case: A 57-year-old postmenopausal woman presents with "tight" feeling in perioral tissues, limited oral opening, difficulty swallowing, and red, firm lips. Medical history reveals no significant past issues except for GERD, hypothyroidism, and a history of child birth. She wears gloves frequently even in air conditioned environments.

Diagnosis: Systemic Sclerosis (Scleroderma)

Findings:

Lip exam (Fig #1): Firmness and lightness in color indicative of collagen deposition characteristic of scleroderma.
Fingers (Fig #2): Reddened tips and distortion at the last joint of the third finger suggesting reduced blood flow (Raynaud’s Phenomenon).

Answers:

1. (b) Excessive collagen deposits of the skin/lip tissue: Scleroderma is characterized by excessive collagen deposition leading to tightness and firmness of the skin, including the lips.

2. (a) Restriction of blood flow to the finger tips: Raynaud’s Phenomenon causes vasospasm, reducing blood flow to the extremities, resulting in reddened, cold fingertips.

3. (a) Telangiectasia: While not explicitly stated, telangiectasia (dilated capillaries) is a common feature of scleroderma and could contribute to the finger tip redness.

4. (d) Blood dyscrasias: Scleroderma is not associated with blood dyscrasias.

5. (b) microstomia: Microstomia, or reduced mouth opening, is a potential symptom of scleroderma.

6. (d) Narrowing of the periodontal ligament: This finding aligns with periodontitis often seen in patients with scleroderma due to poor oral hygiene and limited mouth opening.

7. (a) En coup de sabre: This refers to a localized thickened area of skin resembling a knife wound, which can occur in scleroderma.

8. (c) Acroosteolysis: This is the resorption of terminal phalanges (finger tips) seen in severe cases of scleroderma.