Ch. 9 Allergy/Immunologic, Part 1

Question 1

Transient lingual papillitis other names

Answer 1

bumps, tongue torches

Question 2

Local irritation, inflammation, hormones, stress, hypersensitivity cause a reaction of the ______ papillae in transient lingual papillitis

Answer 2

fungiform

Question 3

3 clinical patterns of transient lingual papilitis

Answer 3

Localized
Generalized
Papulokeratotic

Question 4

Most common location for localized transient lingual papillitis, the condition usually lasts for _____

Answer 4

anterior dorsal tongue

hours to days

Question 5

Causative agent for:
localized TLP
generalized TLP

Answer 5

localized: maybe a food allergy
generalized: maybe viral as it is passed around families

Question 6

Large % of the fungiform papillae located on the ______ tongue are affected in generalized TLP

Answer 6

tip and lateral dorsal

Question 7

T/F papillae involved by papulokeratotic variant of TLP are symptomatic

Answer 7

false- asymptomatic

Question 8

What causes the white appearance of the papulokeratotic variant of TLP

Answer 8

thickened parakeratotic cap

bacterial colonization

Question 9

On average ____% of the population are affected by recurrent aphthous stomatitis

Answer 9

20%

ranges from 5-66%

Question 10

Systemic disorders associated with recurrent aphthous stomatitis (11)

Answer 10

Behcet syndrome
IgA deficiency
Celiac disease
Cyclic neutropenia
Nutritional deficiencies
IBD
HIV and other immunocompromised
Reactive arthritis
-Sweet syndrome: very rare inflammatory skin condition characterized by a sudden onset of fever and painful rash on the arms, legs, trunk, face, or neck.
-MAGIC syndrome: mouth and genital ulcers with inflamed cartilage
-PFAPA syndrome: periodic fever, aphthous stomatitis, pharyngitis, cervical adenitis 
Ulcus vulvae acutum

Question 11

____% of patients with recurrent aphthous stomatitis have some underlying condition

Answer 11

60%

Question 12

3 clinical variants of aphthous stomatitis and their alternative names

Answer 12

Minor aphthous (Mikulicz aphthae)
Major aphthous (Sutton disease)
Herpetiform aphthae

Question 13

what % of aphthae are each type

Answer 13

80% minor
10% major
10% herpetiform

Question 14

which type of aphthae are typically adult onset

Answer 14

herpetiform type

Question 15

Simple vs complex aphthosis

Answer 15

Simple aphthosis: few lesions, heal in 1-2 weeks, recur infrequently
Complex aphthosis: 3 or more lesions, almost constant overlapping bouts of lesions; severe pain and large size are frequent

Question 16

Behcet syndrome alternate names

Answer 16

Behcet disease, Adamantiades syndrome

Question 17

classic triad of behcet syndrome

Answer 17

oral, genital and ocular inflammation

now we include systemic vasculitis

Question 18

What genetic variation is associated with increased risk of Behcet syndrome

Answer 18

HLA-B51

frequent in japan, turkey, and eastern mediterranean

Question 19

demographics of behcets

Answer 19

slight male predominance

3rd-4th decades

Question 20

almost all behcet patients have oral ulcers. Most commonly what type?

Answer 20

Minor, but up to 40% have major type, and only 3% have herpetiform type

Question 21

What % of behcet syndrome patients have genital ulcers?

Answer 21

75%

deep ulcers that tend to scar

Question 22

T/F Blindness occurs in 25% of patients with ocular involvement of behcet disease

Answer 22

True

Question 23

What % of patients with behcet disease have CNS involvement

Answer 23

10-25%

poor prognosis

Question 24

International study group criteria for diagnosis of Behcet disease (no lab criteria)

Answer 24

Major criteria: oral aphthae

(2) Minor criteria: recurrent genital ulcers, eye lesions, skin lesions, positive pathergy test

Question 25

What is a positive pathergy test? What is it used to diagnose

Answer 25

Stick a sterile 20 gauge needle into the skin, inject saline
One to two days later a sterile papule arises
*occurs in 60% of mediterranean behcets patients but only 3% of caucasians
- used to aid in the diagnosis of Behcets

Question 26

what histologic pattern is seen in behcets ulcerations

Answer 26

leukocytoclastic vasculitis

Vessels show: intramural invasion by neutrophils, karyorrhexis(destructive fragmentation of the nucleus) of neutrophils, extravasation of red blood cells, and fibrinoid necrosis of the vessel wall

Question 27

Demographics for sarcoidosis

Answer 27

black, female, before age 50

Question 28

what % of patients with sarcoid are asymptomatic at diagnosis

Answer 28

20%

Question 29

Predominant sites affected by sarcoidosis

Answer 29

lungs, lymph nodes, salivary glands, skin and eyes

*Mediastinal and paratracheal lymph nodes

Question 30

What is a common radiographic sign of sarcoid of chest xray

Answer 30

bilateral hilar LAD

Question 31

what are the indurated skin lesions of the nose,ears,lips and face in sarcoid?

Answer 31

lupus pernio

• Occurs in 25% of patients
• Frequent in head and neck region

Question 32

What is a non-specific skin lesion often on the lower leg in sarcoidosis?

Answer 32

erythema nodosum

Question 33

If sarcoidosis affects the lacrimal gland what condition can it mimic

Answer 33

keratoconjunctivitis sicca of sjogrens syndrome

Question 34

What are the two clinical syndromes of Acute sarcoidosis

Answer 34

1. Lofgren syndrome

2. Heerfordt syndrome

Question 35

Features of Lofgren syndrome

Answer 35

1. erythema nodosum
2. bilateral hilar LAD
3. arthralgia

Question 36

Features of Heerfordt syndrome aka uveoparotid fever

Answer 36

1. parotid enlargement
2. anterior uveitis
3. facial paralysis (ON THE BELLS PALSY DIFFERENTIAL)
4. fever

Question 37

In what % of patients are oral manifestations the first sign of sarcoidosis

Answer 37

2/3 66%

Question 38

Are there intraosseous lesions of sarcoid?

Answer 38

yes- 1/4 of patients

Question 39

3 Histologic buzzwords for sarcoid

Answer 39

• tight epithelioid GRANULOMAS
• Schaumann bodies: laminated basophilic calcifications within the granulomas
• Asteroid bodies: entrapped collagen within the granuloma

Question 40

serum marker that can be elevated in sarcoidosis

Answer 40

60% of patients have elevated ACE

Question 41

What WAS the skin test for sarcoid?

Answer 41

Kveim test (intradermal injection of sterilized suspension of sarcoid tissue)….Not done anymore

Question 42

Helpful diagnostic aid which leads to diagnosis in 93% of patients

Answer 42

parotid biopsy

Question 43

What % of patients have spontaneous resolution of sarcoidosis in 2 years

Answer 43

60%….10-20% of patients do not get resolution even with treatment…4-10% die of cardiac, respiratory, or CNS complications

Question 44

Ocular involvment in sarcoid: 25% of the time and what is the clinical term (presentation)?

Answer 44

anterior uveitis