Chapter 3 Immunity and Immunologic Oral Lesions

Question 1

Dissolution of the intercellular bridges of the prickle cell layer of the epithelium.

Answer 1

Acantholysis

Question 2

An immune response to a foreign substance based on the specific memory of a past exposure to the same foreign substance.

Answer 2

Acquired immune response

Question 3

An immunity based on antibodies developed in response to an antigen, which includes both natural and acquired types.

Answer 3

Active immunity

Question 4

The agents that can be added to a vaccine to modify the immune response.

Answer 4

Adjuvants

Question 5

An antigen that produces a hypersensitivity or allergic reaction.

Answer 5

Allergen

Question 6

Hypersensitivity acquired through exposure to a particular allergen that elicits an exaggerated reaction on re-exposure to the same allergen.

Answer 6

Allergy

Question 7

A severe immediate type of hypersensitivity in which an exaggerated immunologic reaction occurs on re-exposure to a foreign protein or other substance after sensitization, resulting in not only hives, itching, and swelling, but also vascular collapse and shock, as well as death.

Answer 7

Anaphylaxis

Question 8

A lesion that appears as a diffuse swelling of tissue caused by an increased permeability of deeper blood vessels. The skin covering the swelling appears normal.

Answer 8

Angioedema

Question 9

A protein molecule or immunoglobulin that is secreted by plasma cells and reacts with a specific antigen; including five classes: IgA, IgD, IgE, IgG, and IgM.

Answer 9

Antibody

Question 10

The level of antibody in the blood that can be measured by a diagnostic laboratory test.

Answer 10

Antibody titer

Question 11

Any substance able to induce a specific immune response.

Answer 11

Antigen

Question 12

The ability to reduce the virulence of a pathogenic microorganism but still keep it viable, as is done in the development of certain vaccines.

Answer 12

Attenuated

Question 13

An antibody that reacts against a tissue constituent of one’s own body.

Answer 13

Autoantibody

Question 14

An immunopathologic condition characterized by tissue trauma caused by an immune response against tissue constituents of one’s own body.

Answer 14

Autoimmune disease

Question 15

A lymphocyte that develops in lymphoid tissue other than the thymus and that can later differentiate into a plasma cell that produces antibody, the main initiator of humoral immunity.

Answer 15

B-cell lymphocyte

Question 16

An immunity in which the major role is played by the T-cell lymphocytes.

Answer 16

Cell-mediated immunity

Question 17

A white blood cell that acts as an antigen-presenting cell in the skin and mucosa.

Answer 17

Dendritic cell

Question 18

A collection of 50 or more lymphocytes clustered within the salivary gland parenchyma (1 focus = 50 or more lymphocytes). A focus score of 1 or more is compatible with a diagnosis of Sjogren syndrome.

Answer 18

Focus

Question 19

A type of indirect protection from an infectious disease that occurs when a large percentage of the population becomes immune to the infection.

Answer 19

Herd immunity

Question 20

An immunity in which both the B-cell lymphocytes and the antibodies they produce as plasma cells play a predominant role.

Answer 20

Humoral immunity

Question 21

An altered state of reactivity in which the body reacts to a foreign agent such as an allergen with an exaggerated immune response; includes types I through IV.

Answer 21

Hypersensitivity

Question 22

An induction of active immunity, such as when the pathogenic microorganism used to induce active immunity is encountered after vaccination.

Answer 22

Immunization

Question 23

An immunopathologic condition that involves a compromised or entirely absent immune system involving its white blood cells and their products.

Answer 23

Immunodeficiency

Question 24

The proteins secreted by plasma cells that serve as antibodies designed to respond to a specific antigen; includes IgA, IgD, IgE, IgG, and IgM.

Answer 24

Immunoglobulins

Question 25

An agent that alters the immune response by adding or reducing the ability of the response.

Answer 25

Immunomodulator

Question 26

As a cytokine and within the family of glycoproteins, it has immunoregulatory, antineoplastic, and antiviral activity.

Answer 26

Interferon

Question 27

A specialized dendritic cell found in the skin and mucosal tissue that is involved in the immune response.

Answer 27

Langerhans cell

Question 28

Mature neutrophil with a phagocytized spherical inclusion derived from another neutrophil; it is used as a marker of autoimmune diseases.

Answer 28

LE cell

Question 29

The white blood cells involved in the immune response that have three major subsets that include the B-cell lymphocyte, T-cell lymphocyte, and NK cell.

Answer 29

Lymphocytes

Question 30

Tissue composed of lymphocytes supported by a meshwork of connective tissue, including tonsillar tissue, lymph nodes, and lymphatic organs.

Answer 30

Lymphoid tissue

Question 31

The subset of cytokines produced by B-cell or T-cell lymphocytes in contact with antigens that serve as biochemical mediators in an immune response.

Answer 31

Lymphokines

Question 32

A large, tissue-bound, mononuclear phagocyte derived from monocytes circulating in the blood, which can become mobile when stimulated by inflammation and interact with lymphocytes in an immune response as well as during inflammation.

Answer 32

Macrophage

Question 33

A migratory cell of connective tissue that contains many granules of histamine.

Answer 33

Mast cell

Question 34

The subset of cytokines primarily produced by monocytes or macrophages that serve as biochemical mediators in an immune response.

Answer 34

Monokines

Question 35

Affecting both mucosal surfaces (i.e. oral and genital) and skin.

Answer 35

Mucocutaneous

Question 36

The inflammation of a mucosal tissue caused by a disease process.

Answer 36

Mucositis

Question 37

A lymphocyte that is part of the initial innate immune response, which by unknown mechanisms, is able to directly identify and then destroy cells recognized as foreign.

Answer 37

Natural killer cell

Question 38

Diagnostic sign whereby the superficial epithelium separates easily from the basal layer on exertion of firm, sliding manual pressure with the fingers or a tongue blade.

Answer 38

Nikolsky sign

Question 39

An immunity that uses antibodies produced by another person to protect an individual against infectious disease, which includes both natural immunity and acquired immunity.

Answer 39

Passive immunity

Question 40

A nonspecific hypersensitivity reaction, in which a small sterile needle is inserted into the skin of the forearm. A small red bump or pustule will appear at the site of needle insertion in 1-2 days if the test is positive. May be used in the diagnosis of Bechet syndrome.

Answer 40

Pathergy test

Question 41

The cell derived from B-cell lymphocytes that produce antibodies in response to the presence of antigen.

Answer 41

Plasma cell

Question 42

The symptom of severe itching caused by a disease process, possibly a hypersensitivity reaction or allergy.

Answer 42

Pruritis

Question 43

Antibody that binds to certain antibodies found in the serum of patients with rheumatoid arthritis and connective tissue diseases such as Sjogren syndrome. Current assays test for IgM-class rheumatoid factor.

Answer 43

Rheumatoid factor

Question 44

A test that measures lacrimal gland flow by placing special filter paper strips inside the lower eyelid for 5 minutes.

Answer 44

Schirmer test

Question 45

A classic example of type III hypersensitivity that involves a drug allergy to antitoxin serum from horses.

Answer 45

Serum sickness

Question 46

Fibrous adhesion between the eyeball and conjunctiva.

Answer 46

Symblepharon

Question 47

A group of signs and symptoms that occur together in one condition.

Answer 47

Syndrome

Question 48

A lymphocyte that matures in the thymus and is mainly responsible for initiating cell-mediated immunity as well as modulating humoral immunity.

Answer 48

T-cell lymphocyte

Question 49

Organ consisting of lymphoid tissue located high in the chest, which is large in an infant and gradually shrinks in size in adulthood; site of T-lymphocyte maturation.

Answer 49

Thymus

Question 50

Detached rounded cells caused by a loss of attachment between epithelial cells. Also known as acantholytic cells. These cells are present with pemphigus vulgaris.

Answer 50

Tzanck cells

Question 51

Multiple areas of well-demarcated swelling in the skin, usually accompanied by itching. The lesions are caused by localized areas of vascular permeability in the superficial connective tissue beneath the epithelium. Also known as hives.

Answer 51

Urticaria

Question 52

Dryness of the mucous membranes, including the oral cavity; usually caused by hyposalivation or decreased salivary flow.

Answer 52

Xerostomia

Question 53

Appear as “punched-out” round-to-oval ulcers up to 1 cm in diameter. Can have a white to yellow fibrin center, and are common in the anterior part of the mouth. Affect 80% of those with recurrent aphthous ulcers.

Answer 53

Minor aphthous ulcers

Question 54

The smallest type of aphthous ulcer, usually 1-2mm in diameter, and the least common. They can develop anywhere in the oral cavity but are frequently on the lateral aspect of the tongue.

Answer 54

Herpetiform aphthous ulcers

Question 55

Usually larger than 1 cm and are deeper and last longer than minor aphthous ulcers. They can be more painful and usually occur in the posterior part of the mouth. Less common than minor aphthous ulcers.

Answer 55

Major aphthous ulcers

Question 56

Lesions that develop as result of direct contact with an allergen to the oral mucosa or the skin, respectively. Example of a type IV hypersensitivity. Mucosa will become erythematous and edematous, often accompanied by burning and pruritis, it will also be shiny and have a firm consistency.

Answer 56

Allergic contact mucositis/contact dermatitis

Question 57

Lesions that appear in the same site each time a drug is introduced, they appear suddenly after a latent period of several days and then subside when the drug is discontinued. Appears as single or multiple slightly raised, reddish patched or clusters of macules on the skin but rarely the oral cavity. Type III hypersensitivity.

Answer 57

Fixed drug eruptions

Question 58

Is an acute, self-limited disease that affects the skin and mucous membranes. The cause is unclear, but commonly occurs in adults under age 30, and includes a wide range of disease.

Answer 58

Erythema multiforme (EM)

Question 59

EM involving oral mucosa and some skin sites.

Answer 59

Erythema multiforme minor (EM minor)

Question 60

EM with involvement of two or more mucosal sites with widespread skin involvement.

Answer 60

Erythema multiforme major (EM major)

Question 61

A chronic mucocutaneous disease, appears as an arrangement of interconnecting white lines and circles that do not rub off (lace-like pattern). Most common location is the buccal mucosa and can by asymptomatic or symptomatic.

Answer 61

Lichen planus

Question 62

Composed of Whickham striae along with slightly raised white plaque like areas that do not rub off. Often found bilateral on the buccal mucosa, but the tongue, palate, and gingiva may be involved too.

Answer 62

Reticular lichen planus

Question 63

Forms in which the epithelium separates from the connective tissue, resulting in erosions, bullae, or ulcers. These are less common.

Answer 63

Erosive lichen planus/bullous lichen planus

Question 64

Lichen planus that can also present with red, erosive, peeling gingival lesions, a clinical term, not a specific diagnosis.

Answer 64

Desquamative gingivitis

Question 65

A condition in which lesions clinically and histopathologically resemble lichen planus but do not fully meet either characteristic or histopathologic features. Composed of a mixed inflammatory infiltrate rather than only lymphocytes and may extend deeper into connective tissue.

Answer 65

Lichenoid mucositis

Question 66

A chronic, systemic, autoimmune disease that only affects the salivary and lacrimal glands, resulting in a decrease in saliva and tears.

Answer 66

Sjogren syndrome/sicca syndrome

Question 67

Dry eyes

Answer 67

Xerophthalmia

Question 68

Damage to the eyes from a reduced lacrimal flow.

Answer 68

Keratoconjunctivitis sicca

Question 69

Salivary and lacrimal gland involvement without the presence of another autoimmune condition.

Answer 69

Primary Sjogren syndrome

Question 70

When another autoimmune disease accompanies salivary and lacrimal involvement, 50% of those with Sjogren syndrome have another autoimmune condition.

Answer 70

Secondary Sjogren syndrome

Question 71

Occurs in patients with Sjogren syndrome, is a circulatory disorder affecting the fingers and toes. Cold and stress trigger the condition, and skin has a pallor from vasoconstriction followed by cyanosis from decreased blood flow.

Answer 71

Raynaud phenomenon

Question 72

An acute and chronic inflammatory autoimmune disease of unknown cause. Genetic and environmental factors have an influence on the pathogenesis of the disease. Occurs more frequently in women, specifically Black women in childbearing years.

Answer 72

Systemic lupus erythematosus

Question 73

A severe, progressive autoimmune disease that affects the skin and mucous membranes. Characterized by intraepithelial vesicle formation that results from breakdown of the cellular adhesion between epithelial cells.

Answer 73

Pemphigus vulgaris

Question 74

A chronic autoimmune disease that affects the oral mucosa, conjunctiva, genital mucosa, and skin. Occurs in women over 50 years and is not as serious as pemphigus vulgaris. The worst complication is symblepharons.

Answer 74

Mucous membrane pemphigoid/cicatricial pemphigoid/benign mucous membrane pemphigoid

Question 75

A chronic, recurrent, and multisystem autoimmune disease. The manifestations of the syndrome are the result of systemic vasculitis. The pathogenesis is unclear, but oral ulcers, genital ulcers, and ocular inflammation are common manifestations. Skin lesions, GI and genitourinary disease, arthritis, and CNS involvement can occur as well.

Answer 75

Behcet syndrome

Question 76

Manifestation of sarcoidosis, red-to-purple-colored indurated lesions on the skin.

Answer 76

Lupus pernio

Question 77

A type of skin inflammation seen in the lower extremities as a manifestation of sarcoidosis.

Answer 77

Erythema nodosum

Question 78

Are immunodeficiencies of genetic or developmental origin and can involve B cells, T cells, or both.

Answer 78

Primary immunodeficiencies

Question 79

The most common primary immunodeficiency. Effects primarily those of European ancestry, characterized by low levels of both serum and secretory IgA. There is impaired differentiation of B lymphocytes to IgA-producing plasma cells. Results in susceptibility to respiratory, GI, and GU infections. Also increased risk of respiratory allergy, systemic lupus erythematous, and RA.

Answer 79

Isolated IgA deficiency

Question 80

A disorder in which B-cell precursors stop maturing before they complete immunoglobulin gene development. As result plasma cells are deficient and there is a lack of immunoglobulins. Occurs almost always in males and is evident at 6 months old.

Answer 80

Bruton disease

Question 81

A group of genetically inherited syndromes that have defects in both humoral and cell-mediated responses. Infants with these syndromes present with recurrent, severe infections by a wide range of pathogens.

Answer 81

Severe combined immunodeficiency

Question 82

Is a primary immunodeficiency characterized by defects in function of neutrophils. Neutrophils are not able to migrate and are not able to phagocytose and destroy bacteria. This results in persistent bacterial infections, including gingival and periodontal infections.

Answer 82

Leukocyte adhesion deficiency

Question 83

Those that occur as a result of an underlying disorder. Much more common than primary immunodeficiency disorders.

Answer 83

Secondary immunodeficiencies

Question 84

Drugs used to suppress the immune system, like radiation, corticosteroids, drugs used to treat autoimmune disorders, etc.

Answer 84

Immunosuppressive drugs

Question 85

Lack of proper nutrition, caused by not having enough to eat, not eating enough of the right things, or being unable to use the food that one does eat. Causes a physical imbalance.

Answer 85

Malnutrition

Question 86

Disease that involves the renal system (i.e. kidneys).

Answer 86

Renal diseases

Question 87

A virus that attacks cells that help the body fight infection, making a person more vulnerable to other infections and diseases. Will eventually develop into AIDS.

Answer 87

HIV infection

Question 88

A disease that occurs when blood glucose is too high. The body doesn’t make enough insulin or has a resistance to insulin, causing poor regulation of blood glucose. Too much glucose then stays in the blood, and not enough reaches the cells of the body.

Answer 88

Type II diabetes