Immune mediated

Question 1

Is Desquamative Gingivitis a specific disease?

Answer 1

No, it is a clinical term only.

Question 2

What kind of diseases is Desquamative Gingivitis associated with?

Answer 2

Several vesiculoulcerative diseases.

Question 3

Name diseases associated with Desquamative Gingivitis?

Answer 3

Erosive lichen planus and Mucous membrane pemphigoid.

Question 4

What are the clinical features of Desquamative Gingivitis?

Answer 4

Erythema with loss of stippling, vesicle bulla, erosion, and pain.

Question 5

What is the recommended treatment for Desquamative Gingivitis?

Answer 5

Biopsy lesional and adjacent normal epithelium.

Question 6

What kind of disease is Mucous Membrane Pemphigoid?

Answer 6

An autoimmune disease.

Question 7

What oral condition is associated with Mucous Membrane Pemphigoid?

Answer 7

Desquamative gingivitis.

Question 8

What might be seen intraorally in Mucous Membrane Pemphigoid?

Answer 8

May see intact blisters.

Question 9

What are the clinical features of Mucous Membrane Pemphigoid?

Answer 9

Ocular lesion (25%), symblepharon, entropion, trichiasis.

Question 10

What immunofluorescence result is associated with Mucous Membrane Pemphigoid?

Answer 10

Positive direct immunofluorescence.

Question 11

What are the treatments for Mucous Membrane Pemphigoid?

Answer 11

Refer to ophthalmologist and manage oral lesions with steroids.

Question 12

What kind of disease is Pemphigus Vulgaris?

Answer 12

An autoimmune disease targeting epithelial desmosomal complex.

Question 13

What is notable about the oral signs of Pemphigus Vulgaris?

Answer 13

Oral signs are first to show and last to go.

Question 14

What are the clinical features of Pemphigus Vulgaris?

Answer 14

Ragged erosions and ulcerations, flaccid bullae on skin, oral blisters rarely seen, and a positive Nikolsky sign.

Question 15

How should samples be taken for Pemphigus Vulgaris?

Answer 15

Sample lesional periphery for direct immunofluorescence.

Question 16

What are the treatments for Pemphigus Vulgaris?

Answer 16

Systemic corticosteroids and referral to rheumatology and/or dermatology.

Question 17

What is Paraneoplastic Pemphigus associated with?

Answer 17

Lymphoma or leukemia.

Question 18

What condition is Paraneoplastic Pemphigus similar to?

Answer 18

Pemphigus vulgaris with hemorrhagic crusting of lips.

Question 19

What do skin lesions of Lichen Planus look like?

Answer 19

Purple, pruritic, polygonal papules.

Question 20

Where are skin lesions of Lichen Planus typically found?

Answer 20

Flexor surfaces and base of spine.

Question 21

What are the clinical features of Lichen Planus?

Answer 21

Lace like appearance, buccal mucosa, tongue, gingiva, symmetric distribution of interlacing white lines, and 25% of cases have candidiasis.

Question 22

What are the treatments for Lichen Planus?

Answer 22

Anti-fungal medications, topical corticosteroids, more frequent cleanings, home hygiene, and discourage screw retained prostheses.

Question 23

How common is Recurrent Aphthous Stomatitis?

Answer 23

Very common.

Question 24

What kind of condition is Recurrent Aphthous Stomatitis?

Answer 24

Immunologically mediated condition.

Question 25

What are the characteristics of minor aphthae?

Answer 25

Most common, shallow ulcer with erythematous halo.

Question 26

What are the characteristics of major aphthae?

Answer 26

Larger, deeper ulcer, longer duration, and may be associated with HIV or other immunocompromised conditions.

Question 27

What are the characteristics of herpetiform aphthae?

Answer 27

Numerous small lesions.

Question 28

What is the treatment for Recurrent Aphthous Stomatitis?

Answer 28

Topical corticosteroids.

Question 29

What percentage of Erythema Multiforme cases have a precipitating cause?

Answer 29

50%.

Question 30

What usually precipitates Erythema Multiforme?

Answer 30

Usually infection (herpes, m. pneumoniae), less commonly drugs.

Question 31

What is the difference between minor and major Erythema Multiforme?

Answer 31

Minor = skin and/or oral, Major = 2 or more mucosal sites with skin.

Question 32

What are the characteristics of Erythema Multiforme lesions?

Answer 32

Targetoid lesions, ragged margins, hemorrhagic crusting of lips.

Question 33

What is the treatment for Erythema Multiforme?

Answer 33

Corticosteroids.

Question 34

What is Behcet Syndrome associated with?

Answer 34

Oral aphthous ulcers, genital ulcers, and uveitis.

Question 35

What do the ulcers from Behcet Syndrome look like?

Answer 35

Similar to minor, major, or herpetiform aphthae, predilection for soft palate and oropharynx.

Question 36

What is Stevens Johnson Syndrome and Toxic Epidermal Necrolysis triggered by?

Answer 36

Drug exposure.

Question 37

What happens to epithelial cells in Stevens Johnson Syndrome and Toxic Epidermal Necrolysis?

Answer 37

Apoptosis.

Question 38

How much of the body is affected in SJS vs TEN?

Answer 38

SJS if less than 10% of body, TEN if more than 30% of body.

Question 39

Where does Stevens Johnson Syndrome and Toxic Epidermal Necrolysis begin?

Answer 39

On the trunk.

Question 40

What are patients with Stevens Johnson Syndrome and Toxic Epidermal Necrolysis susceptible to?

Answer 40

Infection and electrolyte imbalance.

Question 41

What kind of immunity is involved in Lupus Erythematosus?

Answer 41

Immune mediated involving humoral and cell mediated immunity.

Question 42

What kind of disease is Systemic Lupus Erythematosus?

Answer 42

Systemic disease.

Question 43

What are the clinical features of Systemic Lupus Erythematosus?

Answer 43

Butterfly malar rash, Libman sacks endocarditis, oral ulcerations in 5-25% (up to 40%), similar to erosive lichen planus.

Question 44

What are the clinical features of Chronic cutaneous lupus erythematosus?

Answer 44

Scaly patches and oral lesions like erosive lichen planus.

Question 45

How is Lupus Erythematosus diagnosed?

Answer 45

With anti-dsDNA antibodies and anti-sm antibodies.

Question 46

What is the treatment for Lupus Erythematosus?

Answer 46

Avoid sunlight and use corticosteroids or anti-malarial drugs.