Path Chapter 3

Terms	Definitions
acantholysis	dissolution of the intercellular bridges of the prickle cell layer of the epithelium
acquired immune response	a response fo the body to injury that has memory of past exposure to a foreign substance and responds more quickly to a foreign substance when encountered a second time
allergy	a hypersensitive state scquired through exposure to a particular allergen; reexposure to the same allergen elicits an exaggerated reaction
anaphylaxis	a severe type of hypersensitivity or allergic reaction in which the exaggerated immunologic reaction results from the release of vasoactive substances such as histamine; the reaction occurs on reexposure to a foreign protein or other substance after sensitization
antibody	a protein molecule, also called an immunoglobulin, which is produced by plasma cells and reacts with a specific antigen
antigen	any substance able to induce a specific immune response
autoantibody	an antibody that reacts against an antigenic constituent of the person's own tissues
autoimmune disease	a disease characterized by tissue injury caused by a humoral or cell-mediated immune response against constituents of the body's own tissues
B lymphocyte (B cell)	a lymphocyte, that matures without passing through the thymus; the B cell can later develop into a plasma cell that produces antibodies
cell-mediated immunity	immunity in which the predominant role is played by T lymphocytes
cytokine	cell product produced by the cells involved in the immune response
humoral immunity	immunity in which B lymphocytes and antibodies play the predominant role
hypersensitivity	a state of altered reactivity in which the body reacts to a foreign agent with an exaggerated immune response
immune complex	a combination of antibody and antigen
immunodeficiency	a deficiency of the immune response resulting from hypoactivity or decreased cumbers of lymphoid cells
immunoglobulin (Ig)	a protein, also called an antibody, synthesized by plasma cells in response to a specific antigen
LE cell	a cell that is a characteristic of lupus erythematosis and other autoimmune diseases; it is a mature neutrophil that has pahocytized a spherical inclusion derived from another neutrophil
lymphoid tissue	tissue composed of lymphocytes supported by a meshwork of connective tissue
macrophage	a large tissue-bound mononuclear phagocyte derived from monocytes circulating in blood; they become mobile when stimulated by inflammation and interact with lymphocytes in an immune response
mucositis	mucosal inflammation
natural killer cell (NK cell)	a lymphocyte that is part of the body's initial innate immunity, which by unknown mechanisms is able to directly destroy cells recognized as foreign
Nikolsky's sign	in some bullous disease such as pemphigus vulgaris and bullous pemphigus the superficial epithelium separates easily from the basal layer on exertion of firm, sliding manual pressure
rheumatoid factor	a protein, IgM, found in serum and detectable on laboratory tests; it is associated with rheumatoid arthritis and other autoimmune diseases
T lymphocyte (T cell)	a lymphocyte that matures in the thymus before migrating to tissues; it is responsible for cell-mediated immunity and may modultate the humoral immune response
thymus	a lymphoid organ located high in the chest, which is large in an infant and gradually shrinks in size
xerophthalmia	abnormal dryness of the eyes
xerostomia	patient complaint of dryness of the mouth usually caused by decreased salivary flow
minor aphthous ulcer	E: trauma most common; unclear immunologic pathogenesis a/r/s: more common in younger and women L: oral mucosa not covering bone; ant more than post C: painful, discrete, round to oval yellow-white ulcers, halo of erythema, <= 1 cm in diam Tx: topical corticosteroids; spontaneous healing in 7-10 days Dx: clinical
Major aphthous ulcer	E: unclear immunologic pathogenesis L: oral mucosa not covering bone; often in posterior C: painful, >1 cm in diam; often deeper; may last several weeks; often heal with scarring Tx: topical or systemic corticosteroids; biopsy for differential Dx Dx: clinical, microscopic
herpetiform aphthous ulcers	E: unclear immunologic pathogenesis L: anywhere in oral cavity C: painful, very tiny 1-2 mm ulcers; often occurs in groups Tx: resolve spontaneously; topical corticosteroids; topical tetracycline Dx: clinical
Urticaria (hives)	E: type I hypersensitivity; release of IgG, IgM, ingested allergen, trauma, emotional stress, localized vascular permeability in superficial CT L: skin C: multiple areas of well-demarcated swelling with pruritus Tx: self-limiting episodes; identification & avoidance of causative agent; antihistamine Dx: clinical
angioedema	E: Type I hypersensitivity, trauma, release of IgG, IgM; permeability of deeper blood vessels L: skin or mucosa C: diffuse swelling of tissue; usually no itching Tx: self-limiting episodes; identification of causative agent; antihistamine Dx: clinical
contact mucositis	E: direct contact of allergen with mucosa L: mucosa in contact with allergen C: smooth, shiny, firm mucosa with erythema & edema; may form vesicles; often itching or burning sensation Tx: ID of causative agent; topical and systemic corticosteroids Dx: clinical
contact dermatitis	E: direct contact of allergen with skin L: skin in contact with allergen C: erythema, swelling vesicles to encrusted, scaly, white appearance Tx: ID of causative agent, topical and systemic corticosteroids Dx: clinical
fixed drug eruptions	E: type III hypersensitivity L: same site each episode; usually skin but occasionally oral mucosa C: lesions appear when drug is introduced and subside when discontinued with increasing intensity; single to multiple raised, reddish patches or clusters of macules; pain/ pruritus may be present Tx: ID & discontinuation of causative drug Dx: clinical
erythema multiforme	E: unclear; evidence for hypersensitivity reaction a/r/s: young adults; men L: skin and mucous membranes C: SKIN - characteristic target lesion, also macules, plaques, bullae; MUCOSA - erythema, ulcers, crusted, bleeding lips Tx: ID of causative agent if possible; topical/ systemic corticosteroids Dx: clinical
Stevens-Johnson syndrome	severe form of erythem multiforme; explosive onset
lichen planus	E: unknown a/r/s: broad age range, but increased prevalence in middle age, women L: skin and oral mucosa lesions; oral mucosa: buccal, tongue, labial, floor of mouth, gingiva C: ORAL LESIONS - erosive and plaquelike lesions may occur; Wickham's striae; GINGIVAL - desquamative gingivitis Tx: None (if asymptomatic); topical corticosteroids (if symptomatic); follow up eval Dx: clinical, microscopic
Reactive Arthritis (Reiter Syndrome)	E: abnormal immunologic response to infectious agent; genetic influence (presence of HLA-B27) a/r/s: men affected 10-15:1 compared to women L: conjunctiva, urethra, oral mucosa, skin, knee & ankle joints C: syndrome triad; arthritis, urethritis, conjunctivitis, skin lesions, oral lesions, aphthouslike ulcers; lesions resembling geographic tongue Tx: ASA & NSAIDs Dx: clinical
Sjogren syndrome	E: autoimmune disease; decreased lacrimal & salivary flow L: eyes & oral cavity C: xeropthalmia, xerostomia Tx: saliva substitutes, saliva stimulation, pilocarpine Dx: clinical, radiographic, microscopic, laboratory
Systemic Lupus Erythematosus (SLE)	E: autoimmune disease a/r/s: women 8:1 over men, blacks 3:1 over whites L: multiple sites - skin, mucous membranes, joints, eyes, CNS, kidneys, heart, others C: oral lesions; erythematous plaques or erosions; white striations radiating from center of lesion Tx: antiinflammatory & immunosuppressive agents Dx: laboratory, microscopic, clinical
Pemphigus Vulgaris	E: autoimmune disease a/r/s: children & adults; most common in 4th or 5th decade, more common in Ashkenazic Jews L: mucous membranes; skin C: progressive involvement of mm & skin; oral lesions; painful, wrythema, vesicles, bullae, erosions; positive Nikolsky's sign Tx: corticosteroids and other immunosuppressive agents Dx: laboratory, microscopic
benign mucous membrane pemphigoid	E: autoimmune disease a/r/s: adults L: mucous membranes (gingiva most common) may affect eyes C: oral lesion; desquamative gingivitis, bullae, erosions, ulcers, lesions heal with scarring Tx: topical/ systemic corticosteroids Dx: microscopic
Behcet Syndrome	E: autoimmune disease a/r/s: mean age of onset is 30 L: mucous membranes, oral, genital, ocular C: oral lesions; aphthouslike ulcers Tx: corticosteroids and other immunosuppressive agents Dx: clinical
antigens	the immune system usually defends the body against foreign substances that are called:
It allows faster immune responses	Memory is an important function of the immune system because:
producing active acquired immunity	immunization with a vaccine works by:
is derived from a precursor stem cell	A B lymphocyte is a cell in the immune system that:
can be activated by lymphokines	A macrophage is a cell in the immune system that:
NK cells are part of the body's innate immunity	Which statement is true of NK cells? NK cells do not circulate NK cells secrete antibodies NK cells are part of the body innate immunity NK cells are T lymphocytes
autoimmune disease	In which type of immunopathologic disease are the cells of the body no longer tolerated and treated by the immune system as antigens?
produce antibody called IgE	During the anaphylactic type of hypersenitivity reaction, the plasma cells:
Type II	Which type of hypersensitivity reaction involves activated complement?
T lymphocyte	What type of lymphocyte matures in the thymus, produces lymphokines, and can increase or suppress the humoral immune response?
also called immunoglobulins	In the immune system, antibodies are proteins that are:
immunodeficiency	Which type of immunologic disease involve a decreased number or activity of lymphoid cells?
antibodies	The humoral immune response involves the production of:
titer	The measurement of a spcific antibody level in the blood is called:
acquired passive immunity	Which type of immunity may be provided immediately to dental personnel after needlestick accidents?
use with children	Which of the following situations would result in the least risk of drug allergy? application of topical medication presence of infection presence of multiple allergies use with children
cell mediated immunity	which of the following is involved in the regulation of both humoral and cell-mediated immunity? humoral immunity cell-mediated immunity innate immunity the bone marrow
cytokines	which of the following is involved in the communication between lymphocytes within the immune system? histamine complement bradykinin cytokines
SLE	all of the following are examples of hypersensitivity reactions except: systemic lupus erythematosus urticaria angioedema contact mucositis
an immunologic disorder	reiter syndrome is:
Type IV	which type of hypersensitivity reactions is referred to as delayed hypersensitivity?
erythema multiforme	the "target lesions" on the skin is associated with which of the following diseases? behect syndrome SLE lichen planus erythema multiforme
pemphigus vulgaris	tzanck cells are seen in which of the following conditions? pemphigus vulgaris erythema multiforme SLE behcet syndrome
geographic tongue	the oral lesions in Reiter syndrome may resemble: nicotine stomatitis lichen planus angioedema geographic tongue
Langerhans cell disease	aphthous ulcers are seen in each all of the following systemic disease EXCEPT: behcet syndrome Langerhans cell disease ulcerative colitis cyclic neutropenia
eosinophils and mononuclear cells	the two cell types that histologically characterize Langerhans cell disease are:
Hand-Schuller-Christian disease	which one of the foolowing is the form of Langerhans cell disease that is characterized by a triad of symptoms?
eosinophillic granuloma	the most benign type of langerhans cell disease is:
xerostomia	the most characteristic oral manifestation of Sjogren syndrome is:
skin lesions are common in mucous membrane pemphigoid	which of the following statements is false? - the bullae in pemphigus vulgaris are more fragile than those in bullous pemphigoid - acantholysis of the epithelium is seen in pemphigus vulgaris - in pemphigoid the separation of the epithelium from the CT occurs at the basement membrane - skin lesions are common in mucous membrane pemphigoid
the histologic findings	which is the most distinct and definitive characteristic that distinguishes pemphigus from pemphigoid?
all of the above	desquamative gingivitis may be seen in: cicatricial pemphigoid pemphigus vulgaris lichen planus all of the above
epiglottis	in angioedema involvement of which of the following tissues could create a life-threatening situation for the patient? lips mucosa eyelids epiglattis
lupus erythematosus	which of the following is a pathologic condition that produces a characteristic butterfly-shaped lesion on the face and oral ulcers, occurs more frequently in women, and for which the result of a blood test is important to diagnosis? pemphigus erosive lichen planus desquamative gingivitis lupus erythematosus
angioedema
aphthous ulcer
aphthous ulcers
contact dermatitus
erythema multiforme
erythema multiforme
herpetiform aphthous ulcers
lichen planus
lichen planus
major aphthous ulcer
minor aphthous ulcers
mucous membrane pemphigoid
mucous membrane pemphigoid
pemphigoid vulgaris
pemphigoid vulgaris
pemphigoid vulgaris
raynaud's phenomenon
sjogren syndrome
SLE
urticaria
contact mucositis