Chapter 9: Allergies and Immunologic Diseases

Question 1

___ is a common oral lesion; clinical alterations involve varialbe fungiform papilla and likely represents a hypersentivity or allergy

Answer 1

transient lingual papillitis

Question 2

which type of transient lingual papillitis involves one to several fungiform papilla which become enlarged and are red or yellow, appear on the anteiror dorsal tongue, and are painful?

Answer 2

localized transient lingual papillitis

Question 3

which type of transient lingual papillitis involves a large percentage of fungiform papilla which become enlarged and red, are located on the tip and lateral dorsal tongue, are very sensitive/painful, are associated with fever and lymphadenopathy, and can spread among family members?

Answer 3

generalized transient lingual papillitis

Question 4

which type of transient lingual papillitis involves large number of affected papilla which appear as elevated, yellow or white papules, and is asymptomatic?

Answer 4

diffuse, papulokeratotic variant transient lingual papillitis

Question 5

which type of transient lingual papillitis is associated with fever and lymphadenopathy?

Answer 5

generalized transient lingual papillitis

Question 6

what is the treatment of transient lingual papillitis?

Answer 6

all 3 forms resolve without therapy

for symptomatic forms, topical steroids may reduce pain or duration

Question 7

Answer 7

localized transient lingual papillitis

Question 8

Answer 8

generalized transient lingual papillitis

Question 9

Answer 9

diffuse, papulokeratotic variant transient lingual papillitis

Question 10

recurrent aphthous ulcerations are also called ___

Answer 10

recurrent aphthous stomatitis

Question 11

___ is one of the most common oral mucosal pathoses. what is the prevalence?

Answer 11

recurrent aphthous ulcerations

prevalence is about 30%

Question 12

what is the etiology of recurrent aphthous ulcerations?

Answer 12

no universal etiology; seems to be an allergy or immune dysfunction of some sort

Question 13

recurrent aphthous ulcers occur exclusively on what tissue?

Answer 13

movable mucosa

Question 14

what are the 3 clinical variations of recurrent aphthous ulcers?

Answer 14

• minor (85%)
• major (10%)
• herpetiform (5%)

Question 15

recurrent aphthous ulcerations occur in what age patients?

Answer 15

first occurs in younger patients; 80% have their first ulceration before age 30

Question 16

Answer 16

recurrent aphthous ulceration - minor

Question 17

what is aphthous stomatitis?

Answer 17

• major aphthae
  
  • suttons disease
  • adolescence
  • larger than 1cm
  • can take several weeks to heal
  • may cause scarring

Question 18

which RAU form occurs in childhood?

Answer 18

minor

Question 19

patients with which form of RAU have the fewest recurrences?

Answer 19

minor

Question 20

which RAU lesions are shorter in duration than other variants?

Answer 20

minor

Question 21

what form of RAU will patients typically have a prodrome?

Answer 21

minor

Question 22

how do RAU minor lesions present?

Answer 22

erythematous macule followed by a central yellow-white, removable fibrinopurulent membrane

ulcerations are less than 1cm

Question 23

which types of RAU do not cause scarring?

Answer 23

minor and herpetiform do NOT cause scarring

major MAY cause scarring

Question 24

RAU minor lesions heal without scarring in what time frame?

Answer 24

1-2 weeks

Question 25

there are typically ___ RAU minor lesions per episode

Answer 25

1-5

Question 26

are RAU minor lesions more or less painful than they appear?

Answer 26

more

Question 27

which RAU form occurs in adolescents?

Answer 27

major

Question 28

Answer 28

RAU major

Question 29

are RAU major lesions larger or smaller than minor aphthae?

Answer 29

larger measure about 1-3cm in diameter

Question 30

which RAU type demonstrates the longest duration per episode when compared to other variants, and what is the time frame?

Answer 30

major, takes 2-6 weeks to heal

Question 31

how many lesions per episode occur with RAU major?

Answer 31

1-10

Question 32

what tissues are most commonly involved in RAU major aphthae?

Answer 32

labial mucosa, soft palate, tonsillar fauces

Question 33

Answer 33

RAU herpetiform

Question 34

which RAU form occurs most commonly in adults?

Answer 34

herpetiform

Question 35

of the three RAU types, which one has the greatest number of lesions and recurrences?

Answer 35

* herpetiform * can have up to 100 ulcerations per occurrance * may have continuous lesions for 3 years * recurrences are closely spaced

Question 36

what is the size of RAU herpetiform lesions?

Answer 36

smallest of the 3 variants - 1-3mm in diameter

Question 37

RAU herpetiform lesions heal in what time frame?

Answer 37

7-10 days

Question 38

RAU herpetiform aphthae is more common in males or females?

Answer 38

females

Question 39

what is the general size, healing time, scarring, lesions/episode, and recurrence of RAU minor?

Answer 39

* general size - 3-10mm * healing time - 7-14d * scarring - no * lesions/episode - 1-5 * recurrence - fewest

Question 40

what is the general size, healing time, scarring, lesions/episode, and recurrence of RAU major?

Answer 40

* general size - 1-3cm * healing time - 2-6w * scarring - possible * lesions/episode - 1-10 * recurrence - more than minor, less than herpetiform

Question 41

what is the general size, healing time, scarring, lesions/episode, and recurrence of RAU herpetiform?

Answer 41

* general size - 1-3mm (smallest) * healing time - 7-10d * scarring - no * lesions/episode - up to 100 * recurrence - most

Question 42

what is the treatment for RAU minor?

Answer 42

no treatment or OTC treatment

Question 43

when is it appropriate to prescribe a topical corticosteroid for the treatment of RAU?

Answer 43

* if patient presents with multiple recurrences, many lesions, or intense pain * 0.05% clobetasol proprionate, dispense 15mg, instruct to dry the affected area and apply a thin amount 2x/day as needed * this is a potent steroid so re-emphasize that a little goes a long way

Question 44

\_\_\_ is a chronic, recurrent immune mediated disease with oral aphthous-like ulcerations, ocular inflammation, genital ulcers, and skin lesions

Answer 44

behcet's syndrome | (will not be testing on pictures)

Question 45

\_\_\_ is a common complaint in pateints with behcet's syndrome

Answer 45

joint pain - arthralgia, enlarged joints

Question 46

what is the treatment of behcet's syndrome?

Answer 46

systemic and topical steroids

Question 47

\_\_\_ is a multisystem granulomatous disorder of unknown cause

Answer 47

sarcoidosis

Question 48

of african americans and caucasians, which population is sarcoidosis more prevalent?

Answer 48

african americans

Question 49

what organs are most commonly involved in cases of sarcoidosis?

Answer 49

lungs, lymph nodes, skin, salivary glands, eyes

Question 50

\_\_\_ tissue is involved in almost all cases of sarcoidosis

Answer 50

lymphoid

Question 51

90% of sarcoidosis cases will show abnormal \_\_\_

Answer 51

chest xray

Question 52

what do the skin lesions look like in sarcoidosis patients? what percent of patients with sarcoidosis have skin lesions?

Answer 52

* chronic, purple, indurated lesions on head and neck, termed **lupus pernio** * scattered, nonspecific, tender, red nodules on lower legs termed **erythema nodosum** * 25% of patients

Question 53

what are the 2 different syndrome associated with acute sarcoidosis?

Answer 53

* lofgren's syndrome * heerfordt's syndrome (uveoparotid fever)

Question 54

Answer 54

sarcoidosis

Question 55

what are characteristics of lofgren's syndrome?

Answer 55

* erythema nodosa * bilateral hilar lymphadenopathy * arthralgia

Question 56

what are characteristics of heerfordt's syndrome?

Answer 56

* parotid enlargement * inflammation of the eye * facial paralysis * fever

Question 57

what are the histological featuers of sarcoidosis?

Answer 57

* granulomatous inflammation * schaumann bodies (degenerated lysosomes) * asteroid bodies (entrapped collagen fragments) * hamazaki-wesenberg bodies (large lysosomes)

Question 58

how is sarcoidosis diagnosed?

Answer 58

* elevated serum angiotensin-converting enzyme levels * chest xray * kveim test - no longer used

Question 59

what is the treatment/prognosis of sarcoidosis?

Answer 59

* 60% - symptoms resolve spontaneously in 2 years * corticosteroids if patients have progressive disease * 5-10% succomb to disease

Question 60

what is the presentation of orofacial granulamotosis?

Answer 60

it is variable, but the lips are most commonly involved

Question 61

describe lip involvment with orofacial granulomatosa

Answer 61

* labial tissue presents as a non-tender, persistent swelling * when lips are only involved, it is termed cheilitis granulomatosa

Question 62

melkersson-rosenthal syndrome is a form of \_\_\_

Answer 62

orofacial granulomatosis

Question 63

what are the 3 characteristics of melkersson-rosenthal syndrome?

Answer 63

* cheilitis granulomatosa * facial paralysis * fissured tongue

Question 64

the histology of orofacial granulomatosa is \_\_\_

Answer 64

granulomatous inflammation

Question 65

in order to diagnose orofacial granulomatosis, other diseases causing granulomatous inflammation should be ruled out, such as \_\_\_

Answer 65

sarcoidosis and TB

Question 66

only lips are involved

Answer 66

cheilitis granulomatosa (a form of orofacial granulomatosis)

Question 67

patient also has facial paralysis

Answer 67

melkersson-rosenthal syndrome

Question 68

Answer 68

orofacial granulomatosis

Question 69

Answer 69

wegener's granulomatosis

Question 70

Answer 70

wegeners granulomatosis

Question 71

is wegeners granulomatosis more common in males or females? what is the average age patient who is affected?

Answer 71

* male and female prevalence is equal * average age is 40

Question 72

\_\_\_ is characterized by necrotizing granulomatous lesions of the respiratory tract, with necrotizing glomerulonephritis and systemic vasculitis of small arteries and veins

Answer 72

classic wegener's granulomatosis

Question 73

what can happen if wegener's granulomatosis is untreated?

Answer 73

* rapid renal involvement develops * renal involvement is the most common cause of death

Question 74

what is limited wegener's granulomatosis?

Answer 74

upper respiratory system, no renal lesions

Question 75

what is superficial wegener's granulomatosis?

Answer 75

lesions occur primarily on skin and mucosa

Question 76

visible lesions of wegener's granulomatosa may appear as \_\_\_

Answer 76

nonspecific ulcerations

Question 77

\_\_\_ lesions are characteristics of wegener's granulomatosis

Answer 77

oral

Question 78

what are the oral lesions that are characteristic of wegener's granulomatosis?

Answer 78

* strawberry gingivitis * typically an early manifestation * affected gingiva demonstrates a florid, erythematous, granular hyperplasia

Question 79

how is wegener's granulomatosis diagnosed?

Answer 79

* indirect immunofluorescence detects presence of antineutrophil cytoplasm antibodies (ANCA) * perinuclear (p-ANCA) * cytoplasmic (c-ANCA) - most useful

Question 80

what is the treatment/prognosis for classic wegener's granulomatosis?

Answer 80

* untreated = 10% two year survival * steroids are first-line tx; 75% survive * 30% relapse * cure can be attained if caught early and appropriately treated

Question 81

concentrations of cinnamon flavoring is \_\_\_x that in the natural spice, and can cause \_\_\_

Answer 81

* 100x * contact stomatitis

Question 82

reactions with cinnamon flavoring are most common in products associated with prolonged/frequent contact, including what 3 products?

Answer 82

candy, chewing gum, toothpaste

Question 83

clinical presentation of contact stomatitis from cinnamon varies according to \_\_\_

Answer 83

delivery medium * toothpaste = diffuse * gum/candy = localized

Question 84

\_\_\_ can cause the gingiva to appear large and red, and superficial soughing can occur (much like that seen in patients using sodium lauryl sulfate-containing toothpastes)

Answer 84

contact stomatitis from cinnamon

Question 85

localized contact stomatitis from cinnamon lesions can appear \_\_\_

Answer 85

ulcerated, white, or red

Question 86

signs and symptoms of contact stomatitis from cinnamon disappear within what time frame of discontinuation of cinnamon product?

Answer 86

1 week

Question 87

angioedema is also called \_\_\_

Answer 87

quincke's disease

Question 88

\_\_\_ causes diffuse edemetous swelling of the soft tissues

Answer 88

angioedema

Question 89

Answer 89

contact stomatitis from cinnamon flavoring

Question 90

Answer 90

contact stomatitis from cinnamon flavoring

Question 91

Answer 91

contact stomatitis from cinnamon flavoring

Question 92

Answer 92

angioedema

Question 93

is there pain associated with angioedema?

Answer 93

no, but itching and erythema can be present

Question 94

what is the most common cause of angioedema?

Answer 94

* mast cell degranulation, which leads to histamine release * IgE-mediated hypersensitivity reactions

Question 95

angioedema occurs most commonly on the \_\_\_

Answer 95

extremeties

Question 96

angioedema resolves after how long?

Answer 96

1-2 days

Question 97

what is the treatment for allergic angioedema?

Answer 97

* oral antihistamine therapy * IM epinephrine or IV corticosteroids in severe cases

Question 98

cases of angioedema that include diffuse involvement of the head and neck can be caused by \_\_\_

Answer 98

* angiotensin-converting enzyme inhibitors * -prils (such as lisinopril) - medication for HTN or chronic heart failure

Question 99

what population is angioedema most common in?

Answer 99

african americans 4x more common than in caucasians

Question 100

what health care provider most commonly sees ACE inhibitor-associated angioedema?

Answer 100

oral health care practitioners

Question 101

swelling associated with ACE inhibitor drugs does not respond well to \_\_\_

Answer 101

antihistamines

Question 102

what is the treatment for ACE inhibitor-associated angioedema?

Answer 102

* avoid all medications in this class of drugs * monitor until swelling subsides * some respond well to C1-INH concentrate

Question 103

what are the two types of angioedema?

Answer 103

allergic angioedema and ACE inhibitor-associated angioedema