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Oral Pathology > Ch 3 Immunity > Flashcards

Ch 3 Immunity Flashcards

1
Q

Immune Response

Defends the body against _____
Especially from _____

A

Injury. Especially from microorganism

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2
Q

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

A

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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3
Q

Immune Response

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

A

Injury and damage

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4
Q

Antigens

Foreign substances against which the _____ _____ _____ ___ ____

A

Immune system defends the body

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5
Q

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

A

Tumor cells
Viruses

Organ transplant
Tissue graft
Blood transfusion

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6
Q

Antigens are substances mainly ______________ and their ______

Type of protein, large molecules

A

Microorganisms
Toxins

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7
Q

Autoimmune Disease
part of an individuals ___ ____ _______ _______

A

Own body become antigens

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8
Q

Helper T cells
1st responders

Once all stimulated memory cells differentiate and defend

A

CD4

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9
Q

Cytotoxic
Kill infected cells

A

CD8

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10
Q

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

A

Macrophages

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11
Q

Process of ingestion

A

Phagocytosis

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12
Q

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

A

Get destroyed along with infectious substances

During immune response there is collateral damage

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13
Q

Can occur naturally or can be inquired

Occurs naturally when disease is caused by microorganism

(Work for $)

A

Active immunity

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14
Q

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

A

Measles

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15
Q

Can be acquired by artificial means

Entails getting injected with altered pathogenic microorganisms or their products

Vaccination. Body worked for it either way

A

Active immunity

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16
Q

Using antibodies produced by another person

Can occur naturally or can be acquired

(Parents give $)

A

Passive immunity

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17
Q

Natural passive example

A

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

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18
Q

Acquired passive example

A

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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19
Q

Interval bw start of an infection and appearance of symptoms

The pt is infected but does not know it yet

A

Period of incubation

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20
Q

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

A

Prodromal period

Acquired immunity

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21
Q

Peak of illness intensity

A

Acme

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22
Q

Periods of disease (6)

A

Incubation

Prodromal

Illness

Acme (peak)

Decline

Convalescence

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23
Q

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

A

Aphthous ulcers

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24
Q

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)

A

Aphthous Ulcers

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25
Q

T cell lymphocytes surround ulcer

A

Aphthous ulcers

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26
Q

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

A

Minor Aphthous Ulcer

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27
Q

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

A

Minor aphthous ulcers

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28
Q

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

A

Major aphthous ulcers

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29
Q

Fibron surrounded by red halo

A

Major aphthous ulcers

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30
Q

on ATTACHED GINGIVA

ill (fever, headache)

Contagious

*Systemic manipulation

Do not place steroids

A

Real Herpetic infection

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31
Q

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)

A

Herpetiform aphthous ulcers

32
Q

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

A

No just resembles herpes

33
Q

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?

A

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

34
Q

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

Red halo, shallow, painful

A

Minor aphthae

35
Q

**are common on the lips, soft palate and oral pharynx

Bigger, deeper, scar when healed

A

Major aphthae

36
Q

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

A

Herpetiform aphthae

37
Q

Aphthous ulcers do not occur on hard palate and attached gingiva

True or false

A

True

Distinguishes it from herpes simplex lesion on basis of location

38
Q

Herpetiform aphthous are treated with liquid tetracycline

Does herpes simplex virus respond?

A

No they need to be treated by antiviral agents

39
Q

What is primary therapeutic agent to treat aphthous ulcers?

A

Topical corticosteroids

40
Q

What is often needed for major and herpetiform aphtae?

A

Systemic corticosteroids

41
Q

Also called hives

Appears as multiple areas of WELL DEMARCATED SWELLING of skin

Accompanied by itching

A

Urticaria

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

42
Q

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

A

Urticaria

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

43
Q

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

A

Urticaria

44
Q

Similar to urticaria

DIFFUSE swelling of tissue caused by permeability of DEEPER blood vessels

Skin overlying swelling appears normal

Not accompanied by itching

A

Angioedema

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

45
Q

Increase permeability of blood vessels, plasma leaks out

DEEP structures have swelling
Much more dangerous than urticaria

A

Angioedema

(Angie and her cat edema had deep issues)

46
Q

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

A

Contact mucositis

47
Q

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

A

Contact dermatitis

48
Q

Tx for both contact mucositis and contact dermatitis

A

Topical and systemic corticosteroids

49
Q

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

A

Erythema multiforme

(Self limiting for me to go to target)

50
Q

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

A

Lichen planus - wickhams striae

(Looks like the “plains” interconnecting lines)

51
Q

Types of lichen planus (4)

A

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

52
Q

Lichen planus on gingiva

A

Desquamative gingivitis

53
Q

Mixture of red and white areas

Sore mouth, sensitive to cold and hot, spicy

Areas painful and bleed easy

May need biopsy

A

Erosive lichen planus

54
Q

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

A

Skin lesions

55
Q

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

A

Plaque form of lichen planus

56
Q

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

A

Symptomatic

Topical corticosteroids(especially erosive)

Squamous cell carcinoma

Regular! Soft tissue exams

57
Q

Sjogren’s with another autoimmune disease accompanying it

A

Secondary

58
Q

Sjogren’s with just the lacrimal and salivary gland involvement

A

Primary

59
Q

Can the tongue lose paipila with sojerns?

A

Yes
Becomes non glistening and pale

60
Q

Pale, dry gingival mucosa with marginal inflammation

A

Sjögren’s syndrome

61
Q

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

A

Sjögren’s syndrome

Destroyed and replaced by CT

62
Q

Bilateral enlargement of submandibular glands associated with

A

Sjögren’s

63
Q

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

A

NSAIDS (non steroidal anti inflammatory drugs)

Corticosteroids

64
Q

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)

A

Systemic Lupus Erythematosus

65
Q

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

A

Discoid Lupus

66
Q

blood spots on the skin

A

Purpura

67
Q

Lesions may have white striae resembling lichen planus, but they are less symmetric

Radiate out instead of laced

A

Oral lesions associated with lupus

68
Q

some patients need antibiotic prophylaxis for prevention of bacterial endocarditis

Diagnosis based on multiorgan involvement

A

Oral lesion lupus

69
Q

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

A

Pemphigus Vulgaris

(Vulgar, severe)

70
Q

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.

A

Positive Nikolskys Sign

71
Q

Indicates healing with scars

A

Cicatrical

72
Q

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

A

Breaks away

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

73
Q

C. Pemphigoid
Mucous membrane pemphigoid
Benign mucous membrane pemphigoid

All entities of

A

Cicatrical (heals with scar)

74
Q

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

Diagnosed by

A

Cicatrical pemphigoid

Biopsy and histologic exam

75
Q

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

A

Behcet Syndrome

Oral Pathology (3 decks)

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