immune mediated mucocutaneous lll and lV

Question 1

Cutaneous Lichen Planus is a ____ ____ disease

Answer 1

immune mediated

Question 2

Cutaneous Lichen Planus affects who

Answer 2

1% 30-60 years old

females

Question 3

Cutaneous Lichen Planus, what does it look like?

Answer 3

Purple pruritic polygonal papules with Wickham’s striae

Question 4

Cutaneous Lichen Planus where on the body is it found

Answer 4

Flexor surface of wrists, lumbar region, shins

Question 5

Cutaneous Lichen Planus, how long does it last?

Answer 5

1-2 years disease course.

Question 6

Oral Lichen Planus

Answer 6

may occur alone or with skin lesions. adults females

Question 7

Oral Lichen Planus, where is it found in the oral cavity

Answer 7

bilateral buccal mucosa, tongue, gingiva
reticular form is most common
erosive form is most symptomatic

Question 8

Oral Lichen Planus which form is most common

Answer 8

reticular

Question 9

Oral Lichen Planus which form is most symptomatic

Answer 9

erosive

Question 10

Oral Lichen Planus, how long can it last

Answer 10

years to decades

Question 11

Reticular Oral Lichen Planus

Answer 11

interlacing white lines

Question 12

dorsal tongue involvment

Answer 12

patchy keratosis and atrophy

Question 13

erosive LP:

Answer 13

shallow ulcers, peripheral erythema and radiating white lines

Question 14

_______ may be superimposed over either

Answer 14

C. albicans

Question 15

Histopath characteristics of LP

Answer 15

characteristic microscopic features but these must be correlated with the clinical setting

Hyperkeratosis, alternating atrophy/thickening of spinous layer, pointed rete ridges, degeneration of the basal cell layer and a band-like infiltrate of lymphocytes

Question 16

treatment of the different LP’s

Answer 16

reticular- no treatment

erosive- stronger topical corticosteroids

Question 17

prognosis of LP

Answer 17

good

Question 18

is LP premalignant

Answer 18

to evidence to support this, no

Question 19

Lichenoid Mucositis

Answer 19

A number of conditions can mimic oral lichen planus, both clinically and histopathologically
Lichenoid drug reaction; lichenoid amalgam reaction; oral mucosal cinnamon reaction; lichenoid foreign body gingivitis; oral lesions of GVHD or lupus erythematosus; some epithelial dysplasias


Question 20

Systemic Lupus Erythematosus is the most common of significant immune mediated diseases true or false

Answer 20

TRUE

1.5 mill affected in US

Question 21

Systemic Lupus Erythematosus, whose affected the most

Answer 21

women 8 to 10 times more

average age 31

Question 22

SLE clinically

Answer 22

1. Protean manifestations initially
2. Fever, weight loss, arthritis, fatigue, malaise
3. Malar “butterfly” rash
4. Skin lesions flare with sun exposure

Question 23

this organ is often involved with SLE

Answer 23

Kidney 40-50%

Question 24

most significant clinical complication with SLE

Answer 24

renal failure

Question 25

can also see this organ affected by SLE

Answer 25

cardiac, pericarditis | 50% have vegetation on heart valves

Question 26

frequency of oral involvement?

Answer 26

5-25%

Question 27

SLE oral lesions appear as.....

Answer 27

May appear as non-specific or lichenoid ulcerations/keratotic areas

Question 28

SLE affects what in the oral cavity?

Answer 28

Affect palate, buccal mucosa, or gingiva | can use topical corticosteroids to heal

Question 29

diagnosis of SLE is based on what

Answer 29

clinical, histopathologic, immunopathologic, & serologic findings

Question 30

SLE has a ______ microscopically

Answer 30

Lichenoid pattern

Question 31

SLE has a positive ____ ____ ____, meaning

Answer 31

lupus band test, deposition of immunoreactants at BMZ of normal skin

Question 32

_______ are present 95% of the time, especially to dsDNA

Answer 32

Anti-nuclear antibodies

Question 33

treatments for SLE

Answer 33

avoiding expsure to UV light NSAID's for mild disease systemic corticosteroids for moderate cases

Question 34

prognosis is worse for me or women?

Answer 34

men

Question 35

prognosis of SLE

Answer 35

5 year is 95% | 20 year is 75%

Question 36

most common cause of death of SLE is what

Answer 36

renal failure

Question 37

Chronic Cutaneous Lupus

Answer 37

Related to SLE, but allmost exclusively affects skin and mucosa

Question 38

chronic cutaneous lupus clincal

Answer 38

Scaly, erythematous patches appear on sun-exposed skin of the head and neck Scarring and atrophy as these lesions heal

Question 39

oral lesions of chronic cutaneous lupus resemble what

Answer 39

erosive LP

Question 40

Microscopic examination of oral lesion shows....

Answer 40

lichenoid mucositis and vasculitis

Question 41

Serologic studies typically negative or positive for anti- nuclear antibodies?

Answer 41

negative

Question 42

treatment of chronic cutaneous lupus includes

Answer 42

- avoiding UV light - Topical corticosteroids or calcineurin inhibitors are often helpful with either cutaneous or oral lesions - More difficult cases may require systemic anti-malarial drug therapy or low-dose thalidomide

Question 43

is prognosis better or worse than SLE?

Answer 43

better

Question 44

chance of CCL transforming into SLE?

Answer 44

5%

Question 45

T/F in 50% of cases the skin lesions resolve after several years

Answer 45

true

Question 46

Systemic Sclerosis also called what

Answer 46

scleroderma

Question 47

Systemic sclerosis is a Relatively rare condition characterized by.....

Answer 47

inappropriate deposition of dense collagen | probably immune related

Question 48

systemic sclerosis affects who?

Answer 48

women 3-5 times more | adult

Question 49

systemic sclerosis clinical

Answer 49

1. Raynaud’s phenomenon; claw-like deformity of fingers; acro-osteolysis 2. Diffuse smooth, hard texture of skin 3. Pulmonary, renal, cardiac and GI fibrosis may be seen 4. Pulmonary fibrosis leads to hypertension and heart failure

Question 50

systemic sclerosis oral problems

Answer 50

1. Microstomia, with pinched, “purse-string” appearance of mouth 2. Dysphagia with esophageal involvement 3. Diffuse widening of periodontal ligament 4. Resorption of posterior ramus, condyle, coronoid process or chin in 10-20%

Question 51

systemic sclerosis Serologic studies show....

Answer 51

autoantibodies directed against Scl-70 (topoisomerase I)

Question 52

systemic sclerosis, _____ is seen in biopsy of organs

Answer 52

dense collagen deposition

Question 53

Anticentromere antibodies associated more with.....

Answer 53

CREST syndrome

Question 54

systemic sclerosis treatment

Answer 54

No uniformly effective treatment Supportive care includes esophageal dilation, calcium channel blockers to ease Raynaud’s symptoms, ACE inhibitors to control hypertension Problems with oral hygiene/prostheses 55-60% with diffuse disease survive 10 years; 75-80% with limited disease

Question 55

CREST Syndrome

Answer 55

``` Milder variant of systemic sclerosis Calcinosis cutis, Raynaud’s phenomenon, Esophageal dysfunction, Sclerodactyly, and Telangiectasia ```

Question 56

CREST syndrome affects who the most

Answer 56

women, 6th and 7th decade

Question 57

better or worse prognosis than systemic sclerosis

Answer 57

better

Question 58

treatment for CREST syndrome

Answer 58

symptomatic care.