2. Immune mediated disease Flashcards by Kiki Moriguchi

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Opath II, block 6

Smoking decreases risk

Recurrent apthous stomatitis

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Opath II, block 6

Decrease in CD4/CD8 ratio and increased TNFa, increase in inflammatory mediators (IL2 and 6)

RAS

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Opath II, block 6

Reddish area with slight elecation, often produces tingling sensation , diam., edges are regular , non-jagged, surrounded by a reddish halo

Recurrent apthous stomatitis

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Opath II, block 6

Thialidomide

Tx of type C RAS: teratogenic, don’t give to pregnant women

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Opath II, block 6

Intralesional triamcinolone (kenalog)

RAS - type B (1/mo) for deep ulcers/injections

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Opath II, block 6

DISCONTINUITY OF SF EPITHELIUM. Nonspecific ulcerated* sf covered by fibrouspurulent exudates infiltrated by PMNs. Zone of granulation tissue with dilated capillaries and filled with PMNs macrophages, plasma cells beneath. Deeper layers: repair process

Minor apthous ulcers [RAS: histology]

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Opath II, block 6

**HLA-b51 (mexican, middle eastern, and asians), anticardiolipin antibodies, C-Reactive protein (CRP) elevated, chronic anemia/PMN leukocytolysis (15%)

Behcet syndrome

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Opath II, block 6

Pathergy test (~to a TB test)

Behcet Syndrome

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Opath II, block 6

Crops of mouth ulcers, genital ulcers, eye inflammation

Behcet Syndrome

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Opath II, block 6

Dx: recurrent mouth ulcers with any two of the following (Triad of Systems) : eye inflammation, genital ulcerations, skin abnormalities, and erythema nodosum (skin lesions spontaneously appearing as raised, tender, reddish nodules)

Bechet syndrome

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Opath II, block 6

STDs/Chlamydia

Reactive Arthritis (Reiter’s Syndrome)

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Opath II, block 6

Hemorrhagic crusting of vermillion borders of the lips

Erythema multiforme

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Opath II, block 6

Bulls eye skin lesions

EM Minor

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Opath II, block 6

Steven’s Johnson syndrome

EM Major (acute form: found in young pts)

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Opath II, block 6

Always triggered by Rx rxn, mortality 30-35%, epidermal detachment >30% and results in electolye loss and wide spread infection

TEN (toxic epidermal necrolysis) - most severe form of EM

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Opath II, block 6

Dekeratinization and desquamation of filiform papillae

Geographic Tongue

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Opath II, block 6

Clinical correlation with fissured tongue

Geographic tongue (or Melkersson-Rosenthal syndrome if oral/facial granulomatosis and facial paralysis are also sx)

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Opath II, block 6

Association with psoriasis, seborrheic dermatitis, and atropy

Geographic tongue

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Opath II, block 6

Ageusia, Dysgeusia, lichenoid reaction, epithelial sloughing

Allergic Contact Stomatitis

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Opath II, block 6

Patch test for dental materials, oral flavorings, preservatives, balsam of peru, and cinnamon

Allergic contact stomatitis

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Opath II, block 6

Amalgam sensitivity will cause what kind of rxn

Lechenoid rxn

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Opath II, block 6

Labial enlargement and facial swelling

Melkersson-Rosenthal Syndrome

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Opath II, block 6

Normal epithelium covering connective tissue showing perivascular infiltrate consisting of lymphocytes and plasma cells with multiple discrete epitehlioid granulomas

Orofacial granulomatosis

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# Opath II, block 6 A manifestation of crohns disease, sarcoidosis, and melkersson-rosenthal syndrome

Orofacial granulomatosis

# Opath II, block 6 Serology: sedementation rate, CRP, and ANCA (anti-neutrophil cytoplasmic ab)

Orofacial granulomatosis

# Opath II, block 6 Hypersensitivity due to an inhaled antigen which results in necrotizing franulomatous lesions of the respiratory tract, glomuronephritis

Wegener's granulomatosis

# Opath II, block 6 Strawberry gingivitis

Wegener's Granulomatosis

# Opath II, block 6 Subepithelial split at BM, IgG and C3

MMP

# Opath II, block 6 Abs against collagen VII

Epidemolysis Bullosa Acquisita

# Opath II, block 6 IgA Abs

Linear IgA

# Opath II, block 6 DSG3, suprabasalar spinous layer

Pemphigus Vulgaris

# Opath II, block 6 Tzanck cells

Pemphigus Vulgaris

# Opath II, block 6 Fishnet appearance on IF

Pemphigus Vulgaris

# Opath II, block 6 Patient already diagnosed with cancer

Paraneoplastic Pemphigus

# Opath II, block 6 DSG1, subcorneal split (in spinous layer)

Pemphigus Follaceus

# Opath II, block 6 IVIG, Ritumaxib

Refractory pemphigus

# Opath II, block 6 Wickham's Striae

Reticular LP

# Opath II, block 6 Hyperkeratotic , leukoplakic, raised or flat on tongue and buccal mucosa

Plaque Form LP

# Opath II, block 6 Looks like MMP, but has white striae and is precancerous

Erosive LP

# Opath II, block 6 Large bullae rupture and cause erosion

Bullous LP

# Opath II, block 6 Erosions and white striae around amalgam

Lichenoid reaction

# Opath II, block 6 LP invades the nerve

SCC

# Opath II, block 6 Band of T lymphocytes around BM, thickening of BM, degeneration of basal cells, antifibrinogen Ab

Lichen Planus

# Opath II, block 6 Topical tx that is not a steroid (good for DM and HTN pts)

Tacrolimus

# Opath II, block 6 Malar rash, photosensitivity

Lupus Erythematosis

# Opath II, block 6 ANA+, dsDNA+, anti-smith Abs

Lupus Erythematosis

# Opath II, block 6 Brown tumor

Hyperparathyroidism

# Opath II, block 6 Vitamin D deficiency in children

Rickets

# Opath II, block 6 Vitamin D deficiency in adults

Osteomalacia

# Opath II, block 6 Increased osteoid, decreased mature bone

Rickets/osteomalacia

# Opath II, block 6 Deficiency of bone tissue per unit volume of bone, treat with bisphosphonates

Osteoporosis

# Opath II, block 6 Three diseases with low serum Calcium levels

Primary hyperparathyroidism, rickets and osteomalacia

# Opath II, block 6 Disease with elevated serum Calcium levels

Secondary hyperparathyroidism

# Opath II, block 6 Bleeding gingiva, gingivitis, periodontitis, loosening teeth and eosinophilic granuloma

Hangerhan's cell histocytosis

# Opath II, block 6 Giantism and acromegaly

Hyperpituitarism

# Opath II, block 6 Change in size and of tissues /space btn teeth (less change in bony architecture): enlargement of hypophyseal fossa, thickening of the outer table of the skull, and enlarged paranasal sinuses

Hyperpituitarism

# Opath II, block 6 Mandibular pronathism, increased growth of bone and tissues

acromegaly

# Opath II, block 6 hair on end--radial striations in the diploic space of the skull

Sickle cell anemia/thalassemia

# Opath II, block 6 Rg: changes in bone marrow -- LARGE marrow spaces with thin delicate trabeculae, thin cortical plates, enlarged maxilla but small sinuses

Sickle cell anemia/thalassemia

# Opath II, block 6 Osteomyolitis, hypercementosis, and potential to get osteosarcoma

Paget's Disease

# Opath II, block 6 Bilateral uncontrolled growth of bone w/ cement lines "reversal lines

Paget's Disease

# Opath II, block 6 Similar presentation as fibrous dysplasia except patients are older and have Bilateral lesions

Paget's Disease

# Opath II, block 6 Osteoporosis circumscripta, grandular /ground glass/cotton wool, then RO

Paget's Disease

# Opath II, block 6 Tab tests: increased hydroxyproline in urine (increased collagen destruction), elvated ALP (due to osteoclastic activity), hypercalciuria, and normal serum ca2+

Paget' s Disease

# Opath II, block 6 Sclerodactyly, widening of PDL space, Reynaud's syndrome

Scleroderma

# Opath II, block 6 Enlarged Langerhan's cells, eosinophils and "floating teeth"

Langerhan's cell histiocytosis

# Opath II, block 6 Acute Disseminated LCH

Letter-siwe disease

# Opath II, block 6 Bone lesions, diabetes insipidus and exophthalmos

Hand-Schuller-Christiansen Triad= Multifocal LCH

# Opath II, block 6 PTCH mutation

Gorlin syndrome

# Opath II, block 6 Multiple OKCs and basal cell carcinomas

Gorlin syndrome

# Opath II, block 6 RET mutation

MEN2B

# Opath II, block 6 Marfanoid body build, oral mucosal neuromas, medullary carincoma of the thyroid, pheochromocytoma

MEN2B

# Opath II, block 6 APC mutation

Gardner Syndrome

# Opath II, block 6 Multiple osteomas, impacted teeth, odontomas, 100% develop colorectal carcinoma

Gardner Syndrome

# Opath II, block 6 STK11 mutation

Peutz-Jeghers Syndrom

# Opath II, block 6 Benign polyps, freckle-like spots on perioral skin and hands)

Peutz-Jeghers syndrome

# Opath II, block 6 NF1 mutation

Neurofibromatosis Type 1

# Opath II, block 6 Café au lait spots, crowe's sign, lisch nodules

Neurofibromatosis type 1

# Opath II, block 6 Port wine stains along CN V, leptomeningeal angiomas

Sturge-Weber Angiomatosis

# Opath II, block 6 Hypermobility of joints, elastic skin, gorlin sign

Echler-Danlos Syndrome

# Opath II, block 6 Red papules, family hx, epistaxis, AV-malformation

Hereditary hemorrhagic Telangiectasias

# Opath II, block 6 Peg-shaped incisors, heat intolerance (can't sweat)

Ectodermal Dysplasia

# Opath II, block 6 RUNX2 mutation

Cleidocranial Dysplasia

# Opath II, block 6 Hypoplastic clavicle, delayed eruption of permanent teeth

Cleidocranial Dysplasia

# Opath II, block 6 Café au lait spots, sexual precocity, fibrous dysplasia

McCune-Albright Syndrome

# Opath II, block 6 Fe deficiency + glossitis + dysphagia

Plummer-Vinson Syndrome

# Opath II, block 6 Facial paralysis, swollen lips, fissured tongue

Melkerson-Rosenthal Syndrome

# Opath II, block 6 Esophageal webs

Plummer-Vinson Syndrome

# Opath II, block 6 Erosion, osteophytes, subchondral sclerosis

Osteoarthritis

# Opath II, block 6 Inherited skin condition with no other allergic conditions

Atopic dermatitis

# Opath II, block 6 Scratching leads to excoriations

Eczema

# Opath II, block 6 Itchy skin rash.begins hours after contact

Allergic contact dermatitis

# Opath II, block 6 Excessive contact with irritatnts, causes hand dermatitis

Irritant Contact Dermatitis

# Opath II, block 6 Increased skin cell turnover with slow shedding

Psoriasis

# Opath II, block 6 Auspitz's sign

Psoriasis

# Opath II, block 6 Histamine causes angioedema of lips and hands

Urticaria

# Opath II, block 6 Abnormal C1NH protein

Angioedema (w/out urticaria)

# Opath II, block 6 Tongue blade test

Physical urticaria= dermatographism

# Opath II, block 6 5 physical uticaria

Dermographism, cold uticaria, exercise induced anaphylaxsis, cholenergic uticaria, and contact uticaria

# Opath II, block 6 P. Acnes

Acne

# Opath II, block 6 Affects areas exposed to sunlight over a long period of time, solar elastosis also involved

Solar comedones

# Opath II, block 6 Migraine headaches, sun damage, erythema, telangiectasia

Rosacea

# Opath II, block 6 Mixed population of staph and strep

Impetigo

# Opath II, block 6 Collection of pus in a firm mass caused by S. aureous

Furuncles

# Opath II, block 6 Survive in dead keratin

Dermatophyte infections

# Opath II, block 6 Survive in dead keratin

Dermatophyte infections

# Opath II, block 6 Athlete's foot

Tinea pedis

# Opath II, block 6 Jock itch

Tinea cruris

# Opath II, block 6 Ringworm

Tinea corpuris

# Opath II, block 6 Ringworm of the scalp

Tinea capitus

# Opath II, block 6 Burrow into skin

Scabies

# Opath II, block 6 Do NOT burrow, transmitted by combs

Pediculosis (lice)

# Opath II, block 6 Larvae enter swimmer's pores and die

Swimmer's Itch

# Opath II, block 6 Increased epithelial turnover rate

Dandruff

# Opath II, block 6 Hair loss from crash diets

Telogen effluvium

# Opath II, block 6 Abrupt hair loss from chemo

Anagen effluvium

# Opath II, block 6 Patchy hair loss from autoimmune condition

Alopecia areata

# Opath II, block 6 Jellyfish and coral stinging structures

Nematocyts

# Opath II, block 6 Antimicrobial anti-HIV components of saliva

HIV-specific IgA, SLIPI

# Opath II, block 6 Dark pink submucosal swelling

Lymphoid hyperplasia

# Opath II, block 6 Normal low PMN counts

Benign ethnic neutropenia

# Opath II, block 6 Absence of PMNs, caused by anticancer chemotherapeutic agents

Agranulocytosis

# Opath II, block 6 Periodic reduction in PMN population

Cyclic neutropenia

# Opath II, block 6 Decreased production, increased destruction, sequestration in spleen

Thrombocytopenia

# Opath II, block 6 Increase in mass of RBCs.TIA, CVA, MI

Polycythemia Vera

# Opath II, block 6 Scooped out mandible, floating teeth, large langerhan's cells

Langerhan's cell histiocytosis

# Opath II, block 6 Blast transformation, 9/22 translocation

CML

# Opath II, block 6 Reed-sternberg cells

Hodgkin's Lymphoma

# Opath II, block 6 Owl-eye nucleus

Hodgkin's lymphoma

# Opath II, block 6 B-lymphocytes affected, MALT formation

Non-Hodgkin's Lymphoma

# Opath II, block 6 Cells have minimal cytoplasm

Non-Hodgkin's Lymphoma

# Opath II, block 6 starry sky appearanc

Burkitt's Lyphoma

# Opath II, block 6 Kids, posterior jaws, multiple quadrants affected

Burkitt's Lymphoma

# Opath II, block 6 B-lymphocyte malignancy associated with EBV

Endemic Burkitt's Lymphoma

# Opath II, block 6 Bence-Jones protein, amyloid deposition

Multiple myeloma

# Opath II, block 6 Eccentric nuclei, stippled nuclear chromatin

Multiple myeloma

# Opath II, block 6 Plasma cell origin, Punched out lesions on radiograph

Multiple myeloma

# Opath II, block 6 Glossitis, angular cheilitis, koilonychias, splenomegaly

Anemias

# Opath II, block 6 VIII-A and IX-B deficiency

Hemophilia

# Opath II, block 6 Impaired collagen synthesis results in bleeding gums

Vitamin C deficiency/Scurvy

# Opath II, block 6 White, creamy, removable plaques

Pseudomembranous oral candidiasis (thrush)

# Opath II, block 6 Elongated hyphae, thigmotropism

Oral candidiasis

# Opath II, block 6 Diagnosed using periodic acid Schiff

Oral candidiasis

# Opath II, block 6 Treated with Amphotericin B

Deep Mycoses

# Opath II, block 6 Leads to CNS involvement

Crytococcosis

# Opath II, block 6 Cough, anemia, shiny papules, 3rd most common

Penicilliosis

# Opath II, block 6 Reactivation of latent infection, fever, weight loss

Histoplasmosis

# Opath II, block 6 Reactivation of latent infection, fever, weight loss

Histoplasmosis

# Opath II, block 6 Causes sinus infection and invasive lesions

Aspergillosis

# Opath II, block 6 Viscera, lymph nodes, mucocutanous tissues affected

Blastomycosis

# Opath II, block 6 Pulmonary infection and erythema multiforme

Coccidiomycosis

# Opath II, block 6 Erythematous linear banding, not related to plaque

Linear gingival erythema

# Opath II, block 6 Destruction of one or more interdental papillae

NUG

# Opath II, block 6 Loss of periodontal attachment and bone

NUP

# Opath II, block 6 Ulcers on non-keratinized mucosa

Aphthous ulcers

# Opath II, block 6 Ulcers on keratinized mucosa

HSV

# Opath II, block 6 In HIV, will cross onto the "wet" lip

HSV

# Opath II, block 6 Stops at midline along one dermatome

Herpes zoster

# Opath II, block 6 NO langerhan's cells, chromatin margination, EBV

Oral hairy leukoplakia

# Opath II, block 6 HPV-related lesions

Verruca vulgaris, condyloma acuminatum, focal epithelial hyperplasia

# Opath II, block 6 HHV-8, cancer of lymphatic endothelium and forms blood-filled vascular channels

Kaposi's Sarcoma

# Opath II, block 6 HIV increases risk by 60x

Non-hodgekin's lymphoma

# Opath II, block 6 HIV-related salivary gland disease

Sjogren-like syndrome, diffuse CD8 lymphocytic infiltration (DILS), lymphoepithelial cysts of salivary glands, malignant lymphoma

# Opath II, block 6 Improving immune system reduces Tregs and worsens clinical symptoms

IRIS

# Opath II, block 6 Organophosphate reversal agent

Pralidoxime

# Opath II, block 6 Rx to block muscarine effects

Atropine

# Opath II, block 6 Donepexil

Alzheimers

# Opath II, block 6 Echothiophate, pilocarpine, carbachole-

Glaucoma

# Opath II, block 6 Atropine poisoning and central anticholinergic symptoms

PHYSOstigmine

# Opath II, block 6 Reversal of neuromuscular block (paralysis)

Edrophonium or neostigmine

# Opath II, block 6 Myasthenia gravis

PYRIDOstigmine