Allergies and Immunologic Diseases

Question 1

also known as canker sores

Answer 1

recurrent aphthaous ulcerations

Question 2

waht causes recurrent aphthaous ulcerations

Answer 2

-unknown pathogenesis, immune-mediated process

-

Question 3

who is the most likely to get recurrent aphthalous ulcerations

Answer 3

-children and young adults

Question 4

what are the possible triggers of recurrent aphthaous ulcerations

Answer 4

-stress, local trauma, menstrual cycle

Question 5

what are the three clinical variations of recurrent aphthous ulcerations

Answer 5

• minor
• major
• herpetiform

Question 6

most commone form of recurrent aphthous ulcerations

Answer 6

minor aphthous ulcerations

Question 7

what is the duration of minor aphthous ulcerations?

Answer 7

fewest recurrences and shortest duration of lesions

Question 8

where do minor aphthous ulcerations occur/

Answer 8

EXCLUSIVELY on nonkeratinized mucosa

-buccal and labial mucosa, ventral tongue, floor of mouth and soft palate

Question 9

what is the clinical signs of minor aphthous ulcerations?

Answer 9

1-5 PAINFUL ulcers, preceeded by erytheatous macule

-ERYTHEMATOUS HALO

Question 10

What is the healing process like for minor aphthous ulcerations?

Answer 10

heal WITHOUT scarring 7-10 days

Question 11

what is the rate of recurrence for minor aphthous ulcerations?

Answer 11

highly variable

Question 12

larger than minor aphthous ulcers that are 1-3 cm in diameter that have 1-10 lesions per episode

Answer 12

major aphthous ulcerations

*NO RED HALO

Question 13

what is the healing process like for major aphthous ulcerations?

Answer 13

longer duration per episode than minor, heal in 2-6 weeks often WITH scarring

Question 14

what are the most common sites for major aphthous ulcerations?

Answer 14

• labial mucosa
• soft palate
• tonsillar fauces

Question 15

what is unique about herpetiform aphthous ulcerations?

Answer 15

• greatest number of lesions and most frequent recurrences
• rarely have time period where pt does not have ulcers
• ANY oral mucosal surface
• individual lesions small (1-3mm) with many present per episode

Question 16

what does herpetiform aphthous ulcerations resemble?

Answer 16

superficial resemblence to primary HSV

Question 17

what is the healing process for herpetiform aphthous ulcerations?

Answer 17

heal in 7-10 days but recurrences tend to be closely spaced

Question 18

what is the major difference between primary herpes and herpetiform aphthae?

Answer 18

primary herpes = systemic symptoms

herpetiform aphthae = no systemic symptoms

Question 19

what is the tx for recurrent aphthous ulcerations?

Answer 19

respond well to TOPICAL high - potency corticosteroids

*applied early in course of disease; thin film, multiple times per day

Question 20

MULTISYSTEM disorder with oral aphthous-like ulcerations that has its highest prevalence in Middle East and Japan (much less frequency in US)

Answer 20

Bechet’s syndrome

Question 21

what is the classic triad of Bechet’s syndrome

Answer 21

• oral ulcerations
• genital ulcerations
• ocular disease

Question 22

oral involvement of Bechet’s disease

Answer 22

• first manifestation in 75% of cases
• occurs in 99% of cases
• commonly involves soft palate and oropharynx
• variable size, ragged borders, large zone erythema

Question 23

genital ulcerations of Bechet’s disease

Answer 23

similar in appearance to oral ulcerations

-occur in 75% of cases

Question 24

ocular disease of Bechet’s disease

Answer 24

• occur in 70-85% of cases

- posterior uveitis

Question 25

how do you dx Bechet's disease?

Answer 25

-clinical presentation and positive pathergy test

Question 26

what is the tx for Bechet's disease?

Answer 26

topical or systemic immunosuppressive or immunomodulatory therapy, early aggressive therapy for severe cases

Question 27

what is the px for Bechet's disease/

Answer 27

generally good

Question 28

what causes orofacial granulomatosis?

Answer 28

unknown etiology, appears to represent an abnormal immune reaction

Question 29

who is affected by orofacial granulomatosis the most?

Answer 29

adults

Question 30

what is the clinical presentation of orofacial granulomatosis?

Answer 30

non-necrotizing granulomatous infammation, presenting as persistent non-tender swelling

Question 31

what is the location for orofacial granulomatosis?

Answer 31

lips most common site, may involve ANY oral mucosal or perioral location

Question 32

type of orofacial granulomatosis taht is involvement of the lips alone?

Answer 32

cheilitis granulomatosis

Question 33

type of orofacial granulomatosis that involves: - non-tender lip swelling - bell's palsy - fissured tongue

Answer 33

meldersson-Rosenthal syndrome

Question 34

what is the tx for orofacial granulomatosis?

Answer 34

- thorough medical eval - remove source of inflammation - INTRALESIONAL CORTICOSTEROIDS work best - multiple injections may be necessary

Question 35

what is the px for orofacial granulomatosis?

Answer 35

good

Question 36

granulomatosis that has polyangitis?

Answer 36

wegner's granulomatosis

Question 37

is wegner's granulomatosis common?

Answer 37

no but it is well-recognized

Question 38

where does wegner's granulomatosis affect?

Answer 38

- upper airway - lungs - kidneys - skin - mucosa

Question 39

how serious is wegner's granulomatosis?

Answer 39

condition was uniformly fatal prior to development of current tx modalities

Question 40

type of wegner's granulomatosis that involves the upper and lower respiratory tracts and kidneys

Answer 40

generalized wegner's (classic wegner's)

Question 41

type of wegner's granulomatosis that affects the upper and lower respiratory tract only

Answer 41

limited wegner's

Question 42

type of wegner's granulomatosis that affects the lesions of primarily skin and mucosa

Answer 42

superficial wegner's

Question 43

what is wegner's granulomatosis characterized by?

Answer 43

"strawberry gingivitis"

Question 44

what are the two lab studies that can be used for wegner's granulomatosis?

Answer 44

c-ANCA (cytoplasmic) = most useful | p-ANCA (perinuclear) = also seen in systemic vasculitidies

Question 45

what could happen to limited and superficial forms of wegner's granulomatosis?

Answer 45

progress to classic wegner's granulomatosis

Question 46

what is the clinical appearance of an allergic reaction to systemic drug/

Answer 46

oral mucosa ulceration and erosion with variable erythema and white stripes

Question 47

what re the most common sites for allergic reaction to systemic drugs

Answer 47

- buccal mucosa - labial mucosa - ventro-lateral tongue

Question 48

inflammatory alterations that recur at the same site after the administration of a medication

Answer 48

fixed drug eruption

Question 49

medication induced mucosal alterations which mimic appearance of lichen planus

Answer 49

lichenoid drug reaction

Question 50

how do you dx an allergic rx to systemic drugs

Answer 50

- biopsy (non-specific) - detailed medicinal and clinical history - serial elimination of the medications - mucoal alterations resolve after discontinue meds (recur on reintroduction)

Question 51

what is the tx for allergic reaction to systemic drugs

Answer 51

discontinue responsible meds in conjunction with pt physician +/- topical corticosteroids

Question 52

mild/barley visible erythema to extensive erythema, edema, erosions, ulcerations, and exfoliations

Answer 52

allergic contact stomatosis *may be asymptomatic (burning, itching, stinging)

Question 53

how do you dx allergic contact stomatosis?

Answer 53

- ID of temporal relationship between contact with agent and oral changes - patch testing (insert antigens under skin)

Question 54

what are the three aspects of allergic contact stomatosis?

Answer 54

- dentrifice-realated sloughing - oral mucosal cinnamon reaction - lichenoid amalgam reaction

Question 55

what is dentrifice-related sloughing that is associated with allergic contact stomatosis?

Answer 55

- toothpaste can cause widespread desquamation of the superficial layers of epithelium - minimal/mild erythema - associated with sodium lauryl sulfate

Question 56

what is the tx to dentrifice-related sloughing

Answer 56

no tx necessary, harmless process | -switching to a bland toothpaste will result in resolution

Question 57

what is oral mucosal cinnamon reaciton associated with allergic contact stomatosis?

Answer 57

- contact reaction to artificial cinnamon flavoring - clinical distribution varies by medium of delivery - -toothpaste: diffuse, gingiva - -chewing gum/candy: localized

Question 58

what are the cliinical signs of oral mucosal cinnamon reaction

Answer 58

- erythema with overlying shaggy hyperkeratosis | - pain and burning are common symptoms

Question 59

what is the tx of oral mucosal cinnamon rxs

Answer 59

resolution within one week following discontinuation of the cinnamon product

Question 60

what is a lichenoid amalgam reaction associated with allergic contact stomatosis?

Answer 60

associated with old amalga resotrations undergoing corrosion and release of metallic ions

Question 61

where does lichenoid amalgam reactions occur?

Answer 61

limited to mucosal surfaces directly in contact with the resotration

Question 62

what does the clinical presentation of lichenoid amalgam reactions look like?

Answer 62

may be white or erythematous, +/- peripheral striae

Question 63

what is the tx of lichenoid amalgam reations?

Answer 63

- smooth, polish, recontour old amalgam | - replace amalgam with non-metallic resotration

Question 64

diffuse edematous swelling of soft tissue

Answer 64

angioedema

Question 65

what three things cause angioedema?

Answer 65

- IgE mediated hypersensitivity reaciton (most common) - angiotension-converting enzyme (ACE) inhibitors - C1 esterase inhibitor deficiency

Question 66

what are the clinical features of angioedema?

Answer 66

- relatively rapid onset of soft tissue swelling - non-painful, pruitus and erythema may be seen - solitary or multiple sites of involvement - commonly affects head and neck region - resolution in 24-72 hrs

Question 67

how do you dx angioedema?

Answer 67

- clinical presentation (trigger) | - eval of C1-INH

Question 68

what is the tx of angioedema?

Answer 68

- oral antihistamine, IV corticosteroids - prevention - ACE inhibitor related and C1-INH deficiency non-responsive to standard tx