Ch 3 Immunity Flashcards by McCall S

Immune Response

Defends the body against _____
Especially from _____

Injury. Especially from microorganism

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Immune Response

Differs from ______ response
How? 2 main things

This response involves _____
Primarily the _____ (25% of WBC)
They recognize an antigen and respond to it

Inflammatory

It’s specific (1) and has memory (2) so it responds more quickly to forgein substance 2nd time it enters body

White Blood Cells
Lymphocytes

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Immune Response

May result in an increased level of ______ and ______
To the host due to byproducts from inflammatory and immune response

Injury and damage

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Antigens

Foreign substances against which the _____ _____ _____ ___ ____

Immune system defends the body

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Antigens can be ______ ____, human cells infected by _______
Examples?

Tumor cells
Viruses

Organ transplant
Tissue graft
Blood transfusion

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Antigens are substances mainly ______________ and their ______

Type of protein, large molecules

Microorganisms
Toxins

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Autoimmune Disease
part of an individuals ___ ____ _______ _______

Own body become antigens

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Helper T cells
1st responders

Once all stimulated memory cells differentiate and defend

CD4

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Cytotoxic
Kill infected cells

CD8

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Type of WBC
Ingests foreign substances
Contain lysosomal enzymes that digest antigens
Serve as link bw inflammatory and immune response
Unlike lymphocytes, have no memory

Macrophages

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Process of ingestion

Phagocytosis

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Lysosomal enzymes released into tissue as macrophages digest antigens AND healthy structures.

Get destroyed along with infectious substances

During immune response there is collateral damage

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Can occur naturally or can be inquired

Occurs naturally when disease is caused by microorganism

(Work for $)

Active immunity

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Example of active immunity
If you get it once your body will make antibodies for it.
Protected against further attacks

Immune response has memory, inflammatory response does not

Measles

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Can be acquired by artificial means

Entails getting injected with altered pathogenic microorganisms or their products

Vaccination. Body worked for it either way

Active immunity

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Using antibodies produced by another person

Can occur naturally or can be acquired

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Passive immunity

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Natural passive example

Until own immune system starts working
-Through placenta
-Breast feeding

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Acquired passive example

Ex: I have Hep B vaccine or have and disease itself and produced antibodies. You get a needle stick. Dr takes my antibodies and injects you. you get sick and develop antibodies. Short lived but protected right away,

-Short loved but immediate immunity
-Antibodies given from individuals who has had a disease-naturally produced by their own antibodies

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Interval bw start of an infection and appearance of symptoms

The pt is infected but does not know it yet

Period of incubation

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The beginning of appearance of symptoms

Pt starting to get sick

Progress may end here in the case of ______ _____ against a pathogen
-rapid immune response to infection

Prodromal period

Acquired immunity

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Peak of illness intensity

Acme

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Periods of disease (6)

Incubation

Prodromal

Illness

Acme (peak)

Decline

Convalescence

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Also called canker sores or ______ stomatitis

Painful, recur in episodes, very common (occurs in 20% of population)

Etiology is unclear, but trauma (also dental), stress, and eating certain foods (citrus fruits) are often reported as factors

Aphthous ulcers

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Evidence suggests that they have an immunological basis (accumulation of lymphocytes is present in the lesion)

Occur with some systemic diseases: Chron’s, Colitis, Behcet syndrome

There are 3 types, classified on the basis of their size and duration: minor, major and herpetiform

All three forms of occur on UNATTACHED MUCOSA . That differentiates them from herpes simplex which appears on mucosa fixed to the bone (hard palate, gingiva)

Aphthous Ulcers

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T cell lymphocytes surround ulcer

Aphthous ulcers

Most common type of ulcer round to oval ulcers up to 1 cm in diameter (usually 3-5 mm) shallow Clinical appearance: have a yellowish white fibrin surface surrounded by halo of erythema occur on movable mucosa (not covering bone), may extend onto gingiva more common in anterior part of mouth

Minor Aphthous Ulcer

During the prodromal period of 1 - 2 days symptoms of paresthesia and hyperesthesia in the area are often reported. Paresthesia is a sensation of tingling, pricking (pins and needles). Hyperesthesia an increased sensation to painful stimuli. painful, heal in 7 - 10 days No scarring

Minor aphthous ulcers

Larger than 1 cm in diameter (5-10 mm) Crater-like ulcers Deeper than minor aphtae Last longer than minor aphtae; can take several weeks to heal and may result in scarring also painful may require biopsy to rule out other causes of ulceration such as squamous cell carcinoma, deep fungal infections Most commonly seen in posterior regions of the mouth, but– they can occur anywhere seen in individuals that are HIV+, but not also in otherwise health people

Major aphthous ulcers

Fibron surrounded by red halo

Major aphthous ulcers

on ATTACHED GINGIVA ill (fever, headache) Contagious *Systemic manipulation Do not place steroids

Real Herpetic infection

very tiny (1-2 mm) resemble ulcers caused by herpes simplex virus painful develop on unattached mucosa anywhere in the mouth generally occur in groups they leave no scars ulcers coalesce (to grow together)

Herpetiform aphthous ulcers

Is the term herpetiform real herpes or meaning it just resemble herpes?

No just resembles herpes

Diagnosis of Aphthous Ulcers: Appearance, do not have what? Location which mucosa? Complete pt history they will have … Do systemic signs or symptoms exist in herpetiform?

Distinctive clinical appearance, do NOT from vesicles On mucosa (movable) not fixed to bone. Non keratinized. Location differentiates them from herpes simplex- on mucosa on bone (palate, gingiva) Pt states having reoccurring history of lesions (possible stress) No just in primary herpes simplex infection

**occur on non-keratinized mucosa, most often the labial and buccal mucosa, lateral tongue and floor of the mouth Red halo, shallow, painful

Minor aphthae

**are common on the lips, soft palate and oral pharynx Bigger, deeper, scar when healed

Major aphthae

**are small, clustered lesions, which may occur on KERATINIZED MUCOSA and resemble herpes simplex or other viral lesions.

Herpetiform aphthae

Aphthous ulcers do not occur on hard palate and attached gingiva True or false

True Distinguishes it from herpes simplex lesion on basis of location

Herpetiform aphthous are treated with liquid tetracycline Does herpes simplex virus respond?

No they need to be treated by antiviral agents

What is primary therapeutic agent to treat aphthous ulcers?

Topical corticosteroids

What is often needed for major and herpetiform aphtae?

Systemic corticosteroids

Also called hives Appears as multiple areas of WELL DEMARCATED SWELLING of skin Accompanied by itching

Urticaria (Urt was not hiding his feelings for caria) on the surface he wanted a connection

Caused by localized areas of vascular permeability in superficial connective tissue beneath the SURFACE epithelium (skin)

Urticaria (Urt was not good at hiding his emotions from caria) all on surface, he wanted a connection

Occurs in acute, self-limiting episodes Etiology: Ingested allergens can cause (you eat something and it gives you rash). We really do not know what causes it. Treatment: antihistamines

Urticaria

Similar to urticaria DIFFUSE swelling of tissue caused by permeability of DEEPER blood vessels Skin overlying swelling appears normal Not accompanied by itching

Angioedema (Angie and her cat Ed had DEEP, NOT well defined issues but appeared normal)

Increase permeability of blood vessels, plasma leaks out DEEP structures have swelling Much more dangerous than urticaria

Angioedema (Angie and her cat edema had deep issues)

mucosa becomes erythematous and edematous the area burns and itches where allergen contacted mucosa, and gets a smooth, shiny appearance may get small vesicles, ulcers in area

Contact mucositis

Initially the area may be erythematous with swelling and vesicles Eventually the area becomes encrusted with a scaly, white epidermis can be caused by wearing gloves in dentistry, glove powder

Contact dermatitis

Tx for both contact mucositis and contact dermatitis

Topical and systemic corticosteroids

It is an acute, self-limiting disease affecting skin and mucous membranes The cause is not clear – may be it is a hypersensitivity reaction Skin lesions are called target, iris, or bull’s eye lesions; they are concentric rings of erythema alternating with normal skin color; the color is darkest at the center of the lesion refers to the variety of skin lesions: macules, papules, bullae Oral lesions are: ulcers present on the lateral borders of tongue, crusted and bleeding lips

Erythema multiforme (Self limiting for me to go to target)

It affects skin and oral mucosa, may affect both at same time; some patients only get either oral mucosa or skin lesion alone Skin lesions cause pruritus Wickham’s striae - the interconnecting white lines and circles – are a characteristic of will find small papules in the lesion most common location is buccal mucosa, but can occur anywhere – usually symmetrical more common in middle aged people, slight female predominance

Lichen planus - wickhams striae (Looks like the “plains” interconnecting lines)

Types of lichen planus (4)

Reticular lichen planus -wickhams striae present -most common Erosive lichen planus -epithelium secrets from CT -ulcerated Desquamative gingivitis -can be caused by LP -attached gingiva Skin lesions

Lichen planus on gingiva

Desquamative gingivitis

Mixture of red and white areas Sore mouth, sensitive to cold and hot, spicy Areas painful and bleed easy May need biopsy

Erosive lichen planus

44% of pts who have an oral manifestation will present with _____ _____

Skin lesions

white, raised areas on oral mucosa looks like leukoplakia, typically affects tongue

Plaque form of lichen planus

Tx of lichen planus is indicated only when lesions are _________ ________ ______ used for tx These pts are at increased risk for ______ _____ ______ Therefore they need _____ _____ _____ ____ And biopsy of suspicious lesions not consistent with appearance of lichen planus

Symptomatic Topical corticosteroids(especially erosive) Squamous cell carcinoma Regular! Soft tissue exams

Sjogren’s with another autoimmune disease accompanying it

Secondary

Sjogren’s with just the lacrimal and salivary gland involvement

Primary

Can the tongue lose paipila with sojerns?

Yes Becomes non glistening and pale

Pale, dry gingival mucosa with marginal inflammation

Sjögren’s syndrome

Dry eyes Parotid enlargement (50% of pts) What happens to the parotid gland?

Sjögren’s syndrome Destroyed and replaced by CT

Bilateral enlargement of submandibular glands associated with

Sjögren’s

What should you treat Sjögren’s with first? Like arthritis? Severe cases? Other things useful like saliva substitutes, humidify, sugarless gum, artificial tears, pilocarpine, fluoride, etc

NSAIDS (non steroidal anti inflammatory drugs) Corticosteroids

acute and chronic inflammatory autoimmune disease of unknown cause It is a syndrome. There are many symptoms and signs, that range from skin lesions to a widespread, debilitating disease that involves multiple organ systems. The most common ones include extreme fatigue, painful or swollen joints (arthritis), unexplained fever, skin rashes, and kidney problems The severity of the disease varies. The mildest form is called discoid LE Affects women 8-1 (usually young, 3x more frequent in black women)

Systemic Lupus Erythematosus

Skin lesions They are the most common sign – occur in 85% of individuals Classic skin lesion: “butterfly” rash over the bridge of nose Skin lesions worsen when exposed to sunlight Skin lesion often heal with leaving scars

Discoid Lupus

blood spots on the skin

Purpura

Lesions may have white striae resembling lichen planus, but they are less symmetric Radiate out instead of laced

Oral lesions associated with lupus

some patients need antibiotic prophylaxis for prevention of bacterial endocarditis Diagnosis based on multiorgan involvement

Oral lesion lupus

It is a severe, progressive autoimmune disease It affects skin and mucous membranes ACANTHOLYSIS occurs: adhesions between epithelial cells breakdown and blisters form in these areas Oral lesions – range from shallow ulcers to fragile vesicles to bullae that rupture

Pemphigus Vulgaris (Vulgar, severe)

What is called when you gently press on the mucosa of a patient with Pemphigus Vulgaris? adhesions between epithelial cells break down and form a bulla.

Positive Nikolskys Sign

Indicates healing with scars

Cicatrical

With cicatrical what does the epithelium do in regards to the underlying CT?

Breaks away After pemphigus vulgaris the adhesions of the epithelium and CT were broken down

C. Pemphigoid Mucous membrane pemphigoid Benign mucous membrane pemphigoid All entities of

Cicatrical (heals with scar)

Nikolsky sign can also be observed in this disease (bullae with thick wall) Diagnosed by

Cicatrical pemphigoid Biopsy and histologic exam

Painful ulcers, recurrent - chronic (antibodies to human mucosa) Lesions range from few millimeters to several centimeters Clinical diagnosis: 2 out of 3 signs must be present *oral ulcers, genital ulcers, ocular inflammation Looks similar to aphthous ulcers

Behcet Syndrome

Ch 3 Immunity Flashcards

(75 cards)