Chapter 2 - Inflammation and Repair Flashcards
A decrease in the size and function of a cell, a tissue, an organ, or the body is referred to as
a. emigration.
b. atrophy.
c. hyperplasia.
d. phagocytosis.
b. atrophy.
Atrophy is defined as a decrease in the size and function of a cell, a tissue, an organ, or the whole body. Emigration is the passage of white blood cells through the endothelium and wall of the microcirculation into the injured tissue. Hyperplasia is the enlargement of a tissue or organ resulting from an increase in the number of normal cells. Phagocytosis is the process of ingestion and digestion of particulate material by cells.
he first response of the body to injury is a. anaphylaxis.
b. erythema.
c. fever.
d. inflammation.
d. inflammation
The inflammatory response is the first reaction to injury, and it involves a series of microscopic events. Anaphylaxis is a severe type of hypersensitivity or allergic reaction in which there is an exaggerated immunologic reaction resulting from the release of vasoactive substances such as histamine. Erythema is redness of the skin or mucosa and is a local sign of inflammation. Fever is the elevation of the normal body temperature and is a systemic sign of inflammation.
Which type of inflammation occurs when the injury is minimal and brief and its source is removed from the tissue?
a. Acute
b. Chronic
c. Local
d. Systemic
a. Acute
Acute inflammation occurs when the injury is minimal and brief. Chronic inflammation occurs when the inflammatory response lasts for longer periods, even indefinitely. Local is a term used to describe a specific area of inflammation. Systemic factors such as fever, leukocytosis, and lymphadenopathy occur when the injury is extensive.
Which cell is the first to arrive at the site of injury and is the primary cell type involved in acute inflammation?
a. Macrophage
b. Neutrophil
c. Plasma cell
d. Mast cell
ANS: B
The neutrophil is the first cell to arrive at the site of injury and is the primary cell type involved in acute inflammation. The macrophage is the second cell type to participate in the inflammatory response. The plasma cell is involved in chronic inflammation. The mast cell participates in both the inflammatory and immune responses.
Which symptom is not a classic local sign of inflammation?
a. Redness
b. Swelling
c. Leukocytosis
d. Loss of normal tissue function
c. Leukocytosis
Leukocytosis is an increase in the number of white blood cells and is a sign of systemic inflammation. Redness is a local clinical change at the site of injury and is one of the classic local signs of inflammation. Swelling is a local clinical change observed at the site of injury and is one of the classic local signs of inflammation. Loss of normal tissue function at the site of injury is a classic local sign of inflammation.
Healing of an injury with little tissue loss, such as a surgical incision, is referred to as healing by which type of intention?
a. Tertiary
b. Keloid
c. Secondary
d. Primary
The wearing away of tooth structure during mastication is termed
a. attrition.
b. erosion.
c. abrasion.
d. abfraction.
a. attrition.
Attrition is defined as the wearing away of tooth structure during mastication. Erosion is the loss of tooth structure from chemical action. Abrasion is a pathologic wearing of tooth structure resulting from a repetitive mechanical habit. Abfraction is the result of biomechanical forces on the teeth.
The loss of tooth structure seen in bulimia is caused by
a. anorexia.
b. erosion.
c. attrition.
d. bruxism.
ANS: B
Generalized erosion, especially on the lingual surfaces of maxillary anterior teeth, is caused by frequent vomiting in patients with bulimia. Patients with anorexia nervosa do not vomit after eating. Attrition is the wearing away of tooth structure during mastication. Bruxism occurs when there is nonfunctional grinding or clenching of the teeth.
A patient comes to the office for an emergency visit complaining of a toothache in the left posterior mandible. On clinical examination you notice a gray-to-white patch on the left posterior buccal mucosa. On questioning, the patient tells you that this area is also painful. After reviewing the patient’s medical history, you question the patient regarding his recent use of
a. hydrogen peroxide.
b. aspirin.
c. antibiotics.
d. mouthwash.
b. aspirin.
This is a classic case of aspirin burn caused by the misuse of aspirin. The patient placed aspirin near the tooth that was aching; thus necrosis of the mucosa occurred, resulting in the painful white patch on the buccal mucosa. A chemical burn from the use of hydrogen peroxide would be more diffuse, probably bilateral, and not a white plaque. Antibiotics would be taken systemically and most likely swallowed. Commercial mouthwashes would not cause a localized lesion.
A white raised line observed on the buccal mucosa along the occlusal plane of the teeth is most likely
a. cheek biting.
b. linea alba.
c. white sponge nevus.
d. frictional keratosis.
ANS: B
Linea alba is a raised white line on the buccal mucosa along the occlusal plane; it is considered a variant of normal. Cheek biting is usually seen bilaterally as a diffuse area causing sloughing of the buccal mucosa near the occlusal plane. White sponge nevus is a genetic autosomal-dominant condition. Clinically, it is characterized by a white, soft, folding (corrugation) of the buccal mucosa. A thick layer of keratin produces the whitening effect. Frictional keratosis is caused by a chronic rubbing or friction against the mucosa or alveolar ridge. Diagnosis is made by identifying the trauma causing the lesion and removing the cause.
Which term describes white blood cells adhering to the walls of a blood vessel during inflammation?
a. Margination
b. Pavementing
c. Leukocytosis
d. Emigration
b. Pavementing
Pavementing is the adherence of white blood cells to the walls of a blood vessel during inflammation. Margination is a process during inflammation in which white blood cells move to the periphery of the blood vessel wall. Leukocytosis is a temporary increase in the number of white blood cells circulating in blood. Emigration is the passage of white blood cells through the endothelium and wall of the microcirculation into the injured tissue.
Which symptom is a systemic sign of inflammation?
a. Redness
b. Pain
c. Loss of normal tissue function
d. Fever
d. Fever
Fever is a systemic sign of inflammation. Redness is a local sign of inflammation. Pain is a local sign of inflammation caused by pressure on nerves by exudate formation. Loss of normal tissue function is a local sign of inflammation associated with local swelling and pain.
The enlargement of lymph nodes is termed
a. atrophy.
b. lymphadenopathy.
c. hyperplasia.
d. leukocytosis.
b. lymphadenopathy.
Lymphadenopathy occurs when lymph nodes become enlarged and palpable. Atrophy is a decrease in size and function of a cell, a tissue, an organ, or the whole body. Hyperplasia is an enlargement of a tissue or an organ resulting from an increase in the number of normal cells. Leukocytosis is a temporary increase in the number of white blood cells.
The first microscopic event in the inflammatory response is
a. decreased blood flow.
b. constriction of the microvasculature.
c. phagocytosis.
d. dilation of microvasculature.
b. constriction of the microvasculature.
After injury to the tissue, the first microscopic event is constriction of the microvasculature. Decreased blood flow occurs after exudate formation. Phagocytosis occurs when the white blood cells remove foreign substances from the site by ingestion and digestion; these substances must be removed for the inflammation to resolve. Dilation of the microvasculature is the second microcirculation event to occur after injury.
Serous exudate is composed of which material(s)?
a. Tissue debris and many white blood cells
b. Suppuration
c. Plasma fluids and proteins with a few white blood cells
d. Plasma fluids and red blood cells
c. Plasma fluids and proteins with a few white blood cells
Serous exudate is composed of plasma fluids and proteins with a few white blood cells. Purulent exudate contains tissue debris and many white blood cells. Suppuration is the formation and discharge of pus, as seen in purulent exudate. Serous describes the watery consistency of plasma. Red blood cells are not a component of serous fluid.
When formation of exudate is excessive, a drainage tract may develop through the injured tissue. This channel is often termed
a. a fistula.
b. leukocytosis.
c. erythema.
d. emigration.
a. a fistula.
A fistula is the channel through which excessive exudate passes to drain to the outside. Leukocytosis is a temporary increase in white blood cells. Erythema is redness of the skin or mucosa. Emigration occurs when white blood cells pass through the endothelium and wall of the microcirculation into the injured tissue.
Neutrophils constitute what percentage of the entire white blood cell population?
a. 5%
b. 20%
c. 65%
d. 90%
ANS: C
Neutrophils make up 60% to 70% of all white blood cells. There are significantly more than 5% of neutrophils in the entire white blood cell count. There are significantly more than 20% of neutrophils in the entire white blood cell count. There are fewer than 90% of neutrophils in the entire white blood cell count.
All statements are true concerning the neutrophil except that the neutrophil is
a. the first cell at the site of injury.
b. the primary cell in acute inflammation.
c. the primary cell in chronic inflammation.
d. a phagocyte.
c. the primary cell in chronic inflammation.
In chronic inflammation, the primary cells are macrophages, lymphocytes, and plasma cells. Neutrophils are the first cells at the site of injury. Neutrophils are the primary cells in acute inflammation. The main function of the neutrophil is phagocytosis.
Which system mediates inflammation by causing increased dilation of the blood vessels at the site of injury and increases the permeability of local blood vessels?
a. Kinin system
b. Clotting system
c. Complement system
d. Lysosomal enzymes
a. Kinin system
The kinin system mediates inflammation by causing increased dilation of the blood vessels at the site of injury and increases the permeability of local blood vessels. The clotting mechanism functions primarily in the clotting of blood. The complement system involves the production of a sequential cascade of plasma proteins that function in inflammation and immunity. Lysosomal enzymes are released from granules in the white blood cells; they act as chemotactic factors and can cause damage to connective tissues and the clot that has formed at the site of injury.
Which medication is a steroidal anti-inflammatory drug?
a. Aspirin
b. Prednisone
c. Ibuprofen
d. Motrin
ANS: B
Prednisone is a steroidal anti-inflammatory drug. Aspirin is a nonsteroidal anti-inflammatory agent. Ibuprofen is a nonsteroidal anti-inflammatory agent. Motrin is ibuprofen, a nonsteroidal anti-inflammatory drug.
Which term is defined as an increase in the number of cells in a tissue or organ?
a. Hypertrophy
b. Atrophy
c. Hyperplasia
d. Repair
c. Hyperplasia
Hyperplasia is an increase in the number of cells in a tissue or organ. Hypertrophy is an increase in the size of an organ or tissue but not in the number of cells. Atrophy is a decrease in the size and function of a cell, a tissue, or an organ. Repair is the restoration of damaged or diseased tissue.
Excessive scarring in skin is termed
a. a keloid.
b. healing by primary intention.
c. a hematoma.
d. healing by tertiary intention.
ANS: A
A keloid occurs when there is excessive scarring in the skin. In healing by primary intention, very little granulation tissue forms. A hematoma occurs when there is hemorrhage into the tissue. This may impair healing. Healing by tertiary intention occurs after the infection has been resolved and surgical tissue repair has been performed.
The first sign of attrition is
a. open contacts.
b. disappearance of mamelons on incisors.
c. temporomandibular joint dysfunction.
d. biomechanical forces on the teeth.
b. disappearance of mamelons on incisors.
The first sign of attrition is the disappearance of mamelons on incisors. Open contacts are associated with erosion. Temporomandibular joint dysfunction problems are more likely associated with bruxism. Excessive attrition, muscle pain, and wear facets are present in bruxism. Abfraction results from biomechanical forces on the teeth.
Which habit is not a cause of abrasion?
a. Pipe placement by smokers
b. Playing wind instruments
c. Holding needles or pins with the teeth
d. Frequent sucking of lemons
d. Frequent sucking of lemons
Erosion, not abrasion, can be caused by the frequent sucking of lemons. Abrasion can be caused by pipe placement by pipe smokers. Abrasion may be caused by playing wind instruments. Abrasion can be caused by needles and pins held between the teeth.
This type of erosion is classically associated with
a. anorexia nervosa.
b. bulimia.
c. sucking lemons.
d. abrasive toothpaste.
b. bulimia.
Bulimia is an eating disorder characterized by food binges followed by self-induced vomiting that causes erosion to the lingual aspects of the teeth. Anorexia nervosa is an eating disorder, but it is not associated with erosion because vomiting after eating is not a component of the disorder. Sucking lemons would cause erosion to the facial aspects of the teeth. Abrasive toothpastes are more responsible for contributing to abrasion.
Aspirin burn on the oral mucosa
a. is caused by ingestion of too many aspirin tablets.
b. is caused by placing the aspirin on the tooth with the toothache, causing the surrounding mucosa to become necrotic.
c. is painless.
d. requires a biopsy for diagnosis.
ANS: B
Aspirin burn is caused when aspirin is placed on the tooth with the toothache, causing the surrounding mucosa to become necrotic. Aspirin burn is caused by a topical misuse of aspirin; it is not systemic. Aspirin burn is very painful and slow to heal. Aspirin burn is usually diagnosed by questioning the patient to reveal the cause of the lesion.
Electric burns in the oral area are usually seen in which patient group?
a. Electricians
b. Infants and young children
c. Elderly
d. Individuals involved in an electrical fire
b. Infants and young children
Electric burns in the oral area are most often seen in infants and young children who have bitten or chewed a live electrical cord. Electricians do not usually have electric burns in the oral area. The elderly do not usually have electric burns in the oral area. Individuals in an electrical fire do not usually have electric burns in the oral area.
The diagnosis of a traumatic ulcer is usually based on
a. history of the lesion.
b. scalpel biopsy.
c. therapeutic procedures.
d. laboratory tests.
a. history of the lesion.
Traumatic ulcers are usually diagnosed on the basis of the relationship of the history to the lesion. Scalpel biopsy is not used in the diagnosis of traumatic ulcers. However, if the trauma persists and the ulcer lasts 14 days, a biopsy may be performed. Therapeutic measures are not used to diagnose traumatic ulcers. Laboratory tests are not used to diagnose traumatic ulcers.
The major cause of a mucocele is
a. a sialolith.
b. salivary duct obstruction.
c. trauma to a minor duct.
d. allergic reaction.
c. trauma to a minor duct.
The major cause of a mucocele is trauma to a minor duct. The mucous salivary gland secretion spills into the adjacent connective tissue. A sialolith is a salivary gland stone. Dilated salivary gland ducts are believed to develop as a result of salivary duct obstruction. A mucocele is not caused by an allergic reaction.
Necrotizing sialometaplasia is thought to result from
a. lack of blood supply to the affected salivary gland.
b. a sialolith.
c. trauma to the floor of the mouth.
d. pleomorphic adenoma.
a. lack of blood supply to the affected salivary gland.
Necrotizing sialometaplasia results from lack of blood supply to the affected salivary gland. A sialolith is a salivary gland stone that causes an obstruction in the salivary gland. Necrotizing sialometaplasia occurs on the hard palate, not the floor of the mouth. Pleomorphic adenoma is a benign salivary gland tumor found unilaterally on the posterior palate.
Which choice is most likely to result in frictional keratosis?
a. High-fiber diet
b. Chewing on an edentulous ridge
c. Malignancy
d. Daily use of mouthwash
ANS: B
Frictional keratosis results from chronic chewing on an edentulous ridge. A high-fiber diet does not cause frictional keratosis. Frictional keratosis is not associated with malignancy. Mouthwashes do not cause frictional keratosis.
This lesion on the palate is typically associated with heavy pipe and cigar smoking and is termed
a. tobacco pouch keratosis.
b. necrotizing sialometaplasia.
c. nicotine stomatitis.
d. frictional keratosis.
c. nicotine stomatitis.
Nicotine stomatitis is a benign lesion of the hard palate typically associated with heavy pipe and cigar smoking. Tobacco pouch keratosis occurs in the mucobuccal fold and is caused by chewing/spitting tobacco. Necrotizing sialometaplasia is caused by lack of blood supply to a specific area of the palate. An ulcer is often present. Frictional keratosis results from chronic chewing on an edentulous alveolar ridge.
Traumatic neuroma is a lesion caused by injury to which structure?
a. The epithelium
b. A peripheral nerve
c. A salivary gland
d. Striated muscle
ANS: B
The traumatic neuroma is a lesion caused by injury to a peripheral nerve. The mental foramen is the most common location. The traumatic neuroma does not result from epithelial injury. The traumatic neuroma does not result from injury to a salivary gland. The traumatic neuroma does not result from injury to striated muscle.
Which lesion occurs on the gingiva or alveolar process and contains many multinucleated giant cells, red blood cells, and chronic inflammatory cells?
a. Ranula
b. Central giant cell granuloma
c. Fibroma
d. Peripheral giant cell granuloma
d. Peripheral giant cell granuloma
The peripheral giant cell granuloma occurs on the gingiva or alveolar process; originates from the periodontal ligament; is thought to be a response to injury; and histologically is characterized by many multinucleated giant cells, red blood cells, and inflammatory cells. The ranula is found on the floor of the mouth. The central giant cell granuloma is found within bone. The fibroma occurs most frequently on the buccal mucosa and is composed of dense scarlike connective tissue containing few blood vessels.
Epulis fissuratum is caused by
a. denture adhesive products.
b. poor suction in the palatal vault.
c. poor denture hygiene.
d. an ill-fitting denture flange.
ANS: D
Epulis fissuratum is caused by an ill-fitting denture flange. Denture adhesive products do not cause epulis fissuratum. Poor suction in the palatal vault causes papillary hyperplasia of the palate. Poor denture hygiene does not cause epulis fissuratum.
This granular, erythematous papillary surface of the palatal vault was caused by
a. poor oral hygiene.
b. an ill-fitting suction area of a maxillary denture.
c. the denture flange.
d. soaking the denture in caustic rinses.
b. an ill-fitting suction area of a maxillary denture.
Papillary hyperplasia is caused by the palatal suction of an ill-fitting maxillary denture. Poor oral hygiene does not cause papillary hyperplasia. It may contribute to the inflammatory response of the area. The ill-fitting denture flange causes epulis fissuratum. Soaking the denture in caustic rinses may contribute to inflammation but not papillary hyperplasia.
The most common site for the development of a pulp polyp is
a. the occlusal surface of a large open carious tooth.
b. the apex of the tooth.
c. the gingival margin of the tooth.
d. deep in the pulp canal.
ANS: A
The most common site for the pulp polyp is in the occlusal surface of large open carious teeth. It is seen as a red or pink nodule that fills the occlusal surface. It is an excessive proliferation of chronically inflamed dental pulp tissue. Pulp polyps are not seen at the apex of teeth. Pulp polyps are not seen on the gingival margin of teeth. Pulp polyps are not seen deep in the pulp canal.
The most likely cause of a ranula is
a. inflammation of gland tissue.
b. blockage of blood supply.
c. trauma to a minor duct.
d. salivary duct obstruction.
d. salivary duct obstruction.
Salivary gland obstruction is the most likely cause of a ranula. Inflammation of salivary gland tissue is referred to as sialadenitis. Necrotizing sialometaplasia results from blockage of the blood supply. The major cause of a mucocele is trauma to a minor duct.
These elongated folds of tissue are a result of irritation from an ill-fitting denture. The accurate diagnosis for this lesion is
a. palatal papillomatosis.
b. gingival hyperplasia.
c. chronic hyperplastic pulpitis.
d. epulis fissuratum.
d. epulis fissuratum.
Epulis fissuratum (denture-induced fibrous hyperplasia) consists of elongated folds of tissue as a result of irritation from an ill-fitting denture. Palatal papillomatosis is seen on the palate. Gingival hyperplasia is an enlargement of the gingiva. Chronic hyperplastic pulpitis is an excessive proliferation of chronically inflamed dental pulp tissue.
Chronic hyperplastic pulpitis presents with all symptoms except one. Which is the exception?
a. Pain
b. Can occur in primary and permanent teeth
c. Seen as a pink nodule protruding from the tooth
d. Occurs in teeth with large carious lesions
a. Pain
Since hyperplastic tissue contains few nerves, chronic hyperplastic pulpitis is usually asymptomatic. Chronic hyperplastic pulpitis can occur in both dentitions. Chronic hyperplastic pulpitis appears as a red to pink nodule protruding from the affected tooth. Chronic hyperplastic pulpitis does occur in teeth with large open carious lesions.
________ is a nonspecific response that can be local or systemic. An _____ response is short and only lasts a few days. A _____ response, on the other hand, is a major component of the pathogenesis of common disorders.
inflammation; acute; chronic
