9: allergy Flashcards
(113 cards)
1
Q
behcet syndrome aka and where
A
adamantindes syndrome
oral, genital, ocular lesions
2
Q
pathergy
A
sterile pustule after insertion of steril needle in skin
3
Q
positive pathergy
A
behcet
4
Q
behcet pathergy
A
positive
5
Q
lupus pernio
A
vilocaaous indurated skin lesions in sarcoidosis
6
Q
erythema nodosum
A
sarcoidosis
7
Q
lofgren syndrome
A
erythema nodosum, bilateral hilar LAD, arthralgia
8
Q
erythema nodosum, bilateral hilar LAD, arthralgia
A
lofgren syndrome
9
Q
heertfordt syndrome
A
parotid enlargement, anterior uveitis, facial paralysis, fever
10
Q
parotid enlargement, anterior uveitis, facial paralysis, fever
A
heertfordt syndrome
11
Q
schaumann bodies
A
laminated calcifications (lysosomes) in sarcoid granulomas
12
Q
laminated calcifications (lysosomes) in sarcoid granulomas
A
schaumann bodies
13
Q
asteroid bodies in sarcoid
A
stellate inclusion (entrapped collagen) in sarcoidosis
14
Q
stellate inclusion (entrapped collagen) in sarcoidosis
A
asteroid bodies
15
Q
kveim test
A
sarcoid tissue injected in skin
16
Q
sarcoid tissue injected in skin
A
kveim test
17
Q
wegeners labs
A
c-ANCA and confirm with PR3 ELISA
18
Q
allergic contact stomatitis aka
A
stomatitis venenata
19
Q
quincke dz aka
A
angioedema
20
Q
angioedema aka
A
quincke dz
21
Q
types of angioedema (x3)
A
- IgE hypersensitivity
- ACE inhibitors
- activation of complement pathway - C1 - INH problems (hereditary - type I and II; acquired - lymphoproliferative dz and autoimmune)
22
Q
transient lingual papillities aka and 3 types
A
aka lie bumps, tongue torches
- localized – one or several enlarged fungirform papillae - red papule, may ulcerate, dorsal tongue
- generalized – large % of fungiform papillae on tip/laterl tongue dorsum
- diffuse (papulokeratotis): white/yellow asymptomatic papules (poss frictional keratosis)
23
Q
recurrent aphthous ulcers underlying cellular process
A
T cell reaction - decreased CD4/CD8 ratio, increased T cell receptors, increased TNF
24
Q
types of aphthae and alternative names
A
minor aka mikulicz
major aka sutton or periadenitis mucosa necrotica recurrens
herpetiform
25
simple and ocmplex aphthosis
simple: few lesions, heal 1-2 weeks, few recurrences
complex: >3 lesions, almost constant
26
silver nitrate dangers
used for aphthae
| can cause massive necrosis and systemic argyria
27
behcet syndrome aka
Adamantiades syndrome
28
geography and genetics of behcet
middle east, japan
| HLA B51
29
aphthae in behcet
99% of pts
commonly first sign
more numerous (>6) and dif location (soft palate and oropharynx) than sporadic aphthae
usually minor or majoe
30
genital lesions in behcet
less frequent, deeper, more scarring than oral
31
pathergy
positive in behcet
| sterile pustule after insertion of sterile needle in skin
32
behcet classic histo
leukocytoclastic vasculitis: intramural invasion of n/ph, karyorrhexis of n/ph, RBC extravastion an dfibrinoid necrosis of vessel wall
33
diagnosis criteria for behcet
oral ulcers + 2 of:
- genital lesions
- eye lesions (eveitis, retinal vasculitis, cells in vitrous)
- skin lesions (erythema nodosum, pseudofolliculitis or papulopustular lesions)
or pathergy test
34
sarcoidosis ethnic and age
10-17x more in black
| <50yo
35
predominant sites for sarcoid
lungs, LN, skin, eyes, salivary glands
36
chroni violaceous indurated skin lesions in sarcoid
lupus pernio
37
erythema nodosum
scattered nonspecific tender erythematous nodules on lower legs
e.g., sarcoid
38
lofgren syndrome
erythema nodosum, bilateral hilar LAD, arthralgia
39
erythema nodosum, bilateral hilar LAD, arthralgia
lofgren syndrome
40
heerfordt syndrome aka
uveoparotid fever
| parotid enlargement, anterior uveitis, facial paralysis, fever
41
parotid enlargement, anterior uveitis, facial paralysis, fever
heerfordt syndrome aka uveoparotid fever
42
schaumann bodies
laminated calcifications, degenerated lysosomes
43
asteroid bodies
stellate inclusion, entrapped fragment of collagen
44
laminated calcifications, degenerated lysosomes
schaumann bodies
45
stellate inclusion, entrapped fragment of collagen
asteroid bodies
46
hamazaki weisenberg bodies
small yellow brown structures (large lymphocytes) in LN in sarcoid
47
labs in sarcoid
elevated ACE
48
sarcoid prognosis and mortality
60% resolve within 2y
observe 3-12 months
if needed, steroids
4-10% mortality
49
kveim test
injection of sterile sarcoid
50
non tender persistent swelling of one or both lips
orofacial granulomatosis
51
what to rule out for orofacial granulomatosis
melkerson rosenthal syndrome, Chron's, sarcoid, TB, leprosy, foreign body
52
orofacial granulomatosis involving only lip
cheilitis granulomatosa (of Miescher)
53
granulomatous inflammation on gingiva only: what to rule out
foreign material
54
wegeners granulomatosis locations
granulomatous lesions of respiratory tract, glomerulonephritis, systemic vasulitis
55
types of wegeneres (3)
classic: upper and lower resp tract + rapid renal lesions (aka generalized)
limited: respiratory without renal
superficial (skin and mucosal only, slowly develops systemic)
56
wegeners and nose
saddle nose deformity -- destroys nasal septum
57
oral wegeners
strawberry gingivitis (hyperplastic gingiva with hemorrhagic bulbous projections)
58
strawberry gingivitis
hyperplastic gingiva with hemorrhagic bulbous projections
| oral wegeners
59
hyperplastic gingiva with hemorrhagic bulbous projections
strawberry gingivitis
| oral wegeners
60
non strawberry oral wegeners
ulcerations, facial paralysis, labial mucosa nodules, sinusitis related toothache, TMJ arthralgia, jaw claudication, palatal ulceration, oral-antral fistula, poorly healing extraction
61
histo wegeners
RBC extravastaion close to surgace
| sinonasls: necrosis, vasculitis, granulomatous inflammation
62
wegeners labs
c-ANCA (also for monitoring)
| confirm with PR3 Elisa
63
wegeners tx
prednisons + cyclophosphamide
64
c=ANCA
Wegeners
65
risk of adverse drug rxns with 2, 5, 8+ drigs
6% with 2
50% with 5
100% with 8+
66
patterns of stomatitis medicamentosa
anaphylactic, fixed drug eription, lichenoid, lupus like, pemphigus like, nonspecific vesiculo-ulcerative/aphthous like
67
which drug can prompt PV-like lesions
penicillamine
68
string of pearls on IIF
IgG along basal cell layer -- stomatitis medicametosa
69
circulating antibody in stomatitis medicamentosa
basal cell cytoplasmic antibody
70
stomatitis medicamentosa on IIF
IgG string of pearls
71
allergic contact stomatitis aka
stomatitis venenata
72
contact cinnamon stomatitis histo
mixed infiltrate that obscures connective tissue/epith interface and perivascular inflammation
73
gingiva and allergy
plasma cell gingivitis
74
amalgam allergy
lichenoid contact stomatitis
usually old amalgams
--> erosion and relase of ions
75
lichenoid stomatitis vs lichen planus
no migration, directly relates to dental material, improves upon removal, patch test to dental material positive
76
koebner phenomenon
pts w contact stomatitis but negative patch test
77
pts w contact stomatitis but negative patch test
koebner phenomenon
78
angioedema aka
Quincke's dz
79
mechanisms of angioedema (5)
1- mast cell degranulation (histamine and IgE mediated/allergic)
2 - ACEi and ARB
3 - complement pathway, deficiency of C1-INH activity
4 = high Ab-Ag complexes (lupus, viral/bacterial infx)
5 - elevated peripheral blood eosinophils
80
deficient C1-INH activity
angioedema
hereditary - type I (less C1-INH) and type II (normal levels but dysfunctional C1-INH)
acquired - lymphoprilferative dz (autoAB consumes C1-INH) or autoimmune (autoABbinds to and reduces C1-INH fx)
81
tx for angioedema
allergic - histamine
ACE and hereditary/acquired - C1-INH concentrate
autoimmune - steroids
82
transient lingual papillitis which papillae
fungiform
83
periadenitis mucosa necrotica recurrens
major aphthae (aka sutton)
84
sweet syndrome
```
Febrile neutrophilic dermatosis
High fever
Leukocytosis
Red plaques
Neutrophilia
```
85
Febrile neutrophilic dermatosis
```
sweet syndrome
High fever
Leukocytosis
Red plaques
Neutrophilia
```
86
classic triad of reactive arthritis
1-nongonococcal urethritis
2-conjuctivits
3-arthritis
87
reiter syndrome
reactive arthritis + mucocutaneous component
88
1-nongonococcal urethritis
2-conjuctivits
3-arthritis
reactive arthritis
89
1-nongonococcal urethritis
2-conjuctivits
3-arthritis
4-mucocutaneous component
reiter syndrome
90
behcet HLA
B51
91
violaceous indurated plaques ddx
```
lupus pernio (sarcoid)
lupus vulgaris (TB)
```
92
scattered erythematous nodules on lower leg
erythema nodosum - consider sarcoi
93
degenerated lysosomes in granulomata
schaumann - consider sarcoid
94
entrapped collagen in granulomata
asteroid bodies - consider sarcoid
95
intradermal injection of human sarcoid tissue
kveim test
96
melkersson rosenthal components
1. Facial paralysis
2. Fissured tongue
3. Swelling of lip
97
cheilitis granulomatosa eponym
Miescher
98
types of wegeners
Limited: respiratory system
Superficial: Skin and mucosa
Generalized: respiratory and renal and small arteries (vasculitis)
99
strawberry gingivitis
wegeners
100
4 criteria for wegeners
4 Criteria:
1. Granulomatous inflammation
2. Oral ulcerations
3. Abnormal urinary sediment
4. Cavities on chest wall
101
immunofluorescne in wegeners
Indirect immunofluorescence or serum AB against Anti neutrophilic cytoplasm antibodies
(ANCA)
102
best AB for wegeners diagnosis
1- PR3-ANCA; c-ANCA : proteinase-3 / part of neutrophilic azurophilic cytoplasmic granules
103
proteinase 3
ELISA and PR3-ANCA indirect immunofluorescence for wegeners
104
MPO-ANCA
vasculitides other than wegeners (low specificity)
| MPO-ANCA; p-ANCA: Myeloperoxidase neutrophil lysosomal granules
105
c-ANCA new name
PR3-ANCA
106
p-ANCA new name
MPO-ANCA
107
allergic contact stomatitis sex
F
108
circumoral vs perioral dermatitis
Persistent erythematous papules involving the skin surrounding the vermilion border
there is spared skin ( vs circumoral dermatitis)
109
gold standard tx for perioral dermatitis
oral tetracycline
110
Persistent erythematous papules involving the skin surrounding the vermilion border
there is spared skin
perioral/periorificial dermatitis
111
angioedema vs emphysema
Cervicofacial emphysema:
Air pocket in facial spaces
CREPITUS
112
ethnic angioedema
3-4x more in black ppl
113
poss reasons for angioedema
hypersensitivity (IgE and mast cells)
ACEi *-pril
herediratary (C1-INH -- type 1 *85% less of it, type 2 doesn't work)
acquired - lymphoproliferative dzz and autoimmune
lupus and infections -- higher AG-AB complexes in principle
also w high peripheral eosinophils
