Chapter 3 Flashcards
The breakdown of cellular adhesion between epithelial cells is termed
A) cell-mediated immunity.
B) acantholysis.
C) Nikolsky sign.
D) anaphylaxis.
B) acantholysis.
Acantholysis is the dissolution of the intracellular bridges of the prickle cell layer of epithelium. Cell-mediated immunity is immunity in which the predominant role is played by T-lymphocytes. Nikolsky sign occurs when the superficial epithelium separates easily from the basal layer on exertion of firm, sliding, manual pressure. Anaphylaxis is a severe type of systemic hypersensitivity reaction.
Which protein molecule is produced by plasma cells and is also termed an immunoglobulin?
A) An autoimmune disease
B) A natural killer (NK) cell
C) Rheumatoid factor
D) An antibody
D) An antibody
An antibody is a protein molecule, also called an immunoglobulin, that is produced by plasma cells and reacts with a specific antigen. An autoimmune disease is a disease characterized by tissue injury caused by a humoral or cell-mediated response against constituents of the body’s own tissues. An NK cell is a lymphocyte that is part of the body’s innate immunity. Rheumatoid factor is a protein, immunoglobulin M (IgM), found in serum and detected in laboratory tests. It is associated with rheumatoid arthritis and other autoimmune diseases.
Which lymphocyte matures without passing through the thymus and later can develop into a plasma cell that produces antibodies?
A) T-lymphocyte
B) B-lymphocyte
C) Macrophage
D) LE cell
B) B-lymphocyte
The B-lymphocyte matures without passing through the thymus and later can develop into a plasma cell that produces antibodies. The T-lymphocyte matures in the thymus before migrating to tissues. A macrophage is a large tissue-bound mononuclear phagocyte derived from monocytes circulating in the blood. The LE cell is an atypical mature neutrophil characteristic of lupus erythematosus and other autoimmune diseases.
In which type of immune response do B-lymphocytes and antibodies play the predominant role?
A) Cell-mediated immunity
B) Immune complex
C) Humoral immunity
D) Passive immunity
C) Humoral immunity
In humoral immunity the B-lymphocytes and antibodies play the predominant role. In cell-mediated immunity, the T-lymphocyte plays the predominant role. The immune complex is a combination of antigen and antibody. Passive immunity occurs when antibodies produced by another person are used to protect an individual from an infectious disease.
Which is not a specific component of immunity?
A) A humoral response
B) A cell-mediated response
C) Memory
D) Pavementing
D) Pavementing
Pavementing is the adherence of white blood cells to the walls of a blood vessel during an inflammatory response. Humoral immunity involves the production of antibodies. The B-lymphocyte is the predominant cell. Cell-mediated immunity involves the T-lymphocyte. Memory is an important function of the immune system. Certain lymphocytes retain the memory of an antigen after an initial encounter, allowing for faster immune responses.
An example of natural passive immunity occurs when
A) antibodies from a mother pass through the placenta to the developing fetus.
B) a microorganism causes a disease.
C) a person receives a vaccination.
D) a person is immunized.
A) antibodies from a mother pass through the placenta to the developing fetus.
Natural passive immunity occurs when antibodies from a mother pass through the placenta to the developing fetus. Active immunity occurs naturally when a microorganism causes a disease. Active acquired immunity occurs as a result of vaccination. After vaccination, the immune system produces a stronger response and prevents the development of the disease. This production of acquired immunity is called immunization.
Which is an example of type I hypersensitivity?
A) Immune complexes formed between microorganisms and antibody in the
B) circulating blood
C) Asthma
D) Autoimmune hemolytic anemia
E) Serum sickness
C) Asthma
Asthma is an example of type I hypersensitivity. In type III hypersensitivity, immune complexes are formed between microorganisms and antibody in the circulating blood. Autoimmune hemolytic anemia is a type II hypersensitivity reaction. Serum sickness is a classic example of a type III hypersensitivity reaction.
Which route of drug administration causes the most significant hypersensitivity reaction?
A) Topical
B) Patch
C) Parenteral
D) Oral
C) Parenteral
When the reaction occurs after parenteral administration (injection), it may be more severe because the allergen can be carried quickly to many parts of the body through the bloodstream. It takes more time for topically applied drugs to enter the bloodstream compared with parenterally applied (injected) drugs. It takes more time for a drug to enter the bloodstream via a patch compared with parenteral administration. It takes more time for oral medications to enter the bloodstream than parenterally applied drugs.
Which is a condition that involves a deficiency in number, function, or interrelationships of the involved white blood cells and their products?
A) Autoimmune disease
B) Leukocytosis
C) Immunodeficiency
D) Anaphylaxis
ANS: C
Immunodeficiency is a type of immunopathologic condition that involves a deficiency in number, function, or interrelationships of the involved white blood cells and their products. Autoimmune disease is characterized by tissue injury caused by a humoral or cell-mediated immune response against constituents of the body’s own tissues. Leukocytosis is an increase in the circulating white blood cells. It is a systemic sign of an inflammatory response. Anaphylaxis is a severe type of hypersensitivity reaction.
What is the most common precipitating factor in the development of aphthous ulcers?
A) Allergy
B) Trauma
C) Systemic disease
D) Citrus foods
B) Trauma
Trauma is the most common precipitating factor in the development of aphthous ulcers. Allergies do not cause aphthous ulcers. Aphthous ulcers do occur in association with certain systemic diseases, but they are not the most common precipitating factor. Citrus foods can trigger episodes of aphthous ulcers, but they are not the most common precipitating factor.
Certain recurrent ulcers appear on movable mucosa. These ulcers are discrete, round-to-oval, 3 to 5 mm in diameter and exhibit a yellowish-white fibrin center surrounded by an erythematous halo. These ulcers are termed
A) major aphthous ulcers.
B) Sutton disease.
C) herpetiform aphthous ulcers.
D) minor aphthous ulcers.
D) minor aphthous ulcers.
Minor aphthous ulcers are recurrent and appear on movable mucosa. They are 3 to 5 mm in diameter and have a yellowish-white fibrin center surrounded by an erythematous halo. Major aphthous ulcers are deeper in the tissue, are larger (5 to 10 mm), take much longer to heal, and often heal with scarring. Sutton disease is the same as major aphthous ulcers. Herpetiform aphthous ulcers are very tiny (1 to 2 mm). The size of this type of aphthous ulcer is similar to the size of ulcers caused by the herpes simplex virus.
Which ulcer may require a biopsy to make the diagnosis?
A) Minor aphthous
B) Major aphthous
C) Herpetiform aphthous
D) Behçet syndrome
B) Major aphthous
Major aphthous ulcers sometimes require a biopsy to rule out other causes of ulceration such as squamous cell carcinoma or deep fungal infections. Minor aphthous ulcers are diagnosed through clinical appearance, location, and complete patient history. Herpetiform aphthous ulcers resemble those associated with the herpes simplex virus, but there are no systemic signs or symptoms as in primary herpes simplex infection. Behçet syndrome is a multisystem disorder characterized by numerous clinical manifestations. Although there are oral ulcerations, the diagnosis requires the presence of other features such as genital, ocular, and skin lesions.
Antihistaminic drugs are the principal method of treatment for
A) urticaria.
B) minor aphthous ulcers.
C) herpetiform aphthous ulcers.
D) contact mucositis.
A) urticaria.
Urticaria, also called hives, appears as well-demarcated areas of swelling on the skin accompanied by pruritus. The release of the chemical mediator histamine causes the increased vascular permeability. Antihistaminic drugs are used to treat urticaria. Minor aphthous ulcers heal spontaneously in 7 to 10 days. They may be treated with topical corticosteroid or nonsteroidal antiinflammatory medications. Herpetiform aphthous ulcers do not respond to antihistaminic drugs. They may respond to corticosteroid therapy or topical liquid tetracycline. Contact mucositis results from direct contact of an allergen with the mucosa. Treatment begins with removal of the cause.
A prodromal period begins
A) 1 week before the onset of ulcers.
B) 1 to 2 days before the onset of ulcers.
C) the day the ulcers erupt.
D) 7 to 10 days before ulcers erupt.
B) 1 to 2 days before the onset of ulcers.
The prodromal period occurs 1 to 2 days before ulcers appear. There are a burning sensation and soreness where the ulcers will appear. The prodromal period before ulceration is only 1 to 2 days. Prodromal symptoms should not occur 1 week before ulceration. The prodromal period does not occur on the day of ulceration. The prodromal period precedes ulceration by only 1 to 2 days. Prodromal symptoms should not occur 7 to 10 days before ulceration.
A condition thought to be a hypersensitivity reaction is characterized by skin and mucous membrane lesions. The skin lesions are referred to as target, iris, or bull’s eye lesions. The lip and mucosal lesions are more extensive and painful and often appear bloody and crusted. The intraoral lesions are extensive superficial ulcerations. The onset is explosive. On the basis of these clinical features, what condition is suspected?
A) Erythema multiforme
B) Fixed drug reaction
C) Behçet syndrome
D) Angioedema
ANS: A
Erythema multiforme is a hypersensitivity reaction that affects the skin and mucous membranes. Bloody crusted lips are a common presentation. The onset is explosive, and the skin lesions are referred to as target, iris, or bull’s eye lesions. Fixed drug eruptions are lesions that appear in the same site each time a drug is introduced. There may be a single red patch or macule on the skin. Mucous membranes are rarely involved. Behçet syndrome is a chronic recurrent autoimmune disease consisting primarily of oral ulcers, genital ulcers, and ocular inflammation. Angioedema appears as a diffuse swelling of tissue caused by permeability of deeper blood vessels.
Wickham striae is a term used to describe the oral mucosal lesions of
A) linea alba.
B) frictional keratosis.
C) lichen planus.
D) erythema multiforme.
C) lichen planus.
Wickham striae describe the slender white lines seen in lichen planus. Linea alba is the white line on the buccal mucosa that extends anteroposteriorly along the occlusal plane. Frictional keratosis occurs when there is chronic cheek and tongue chewing and chewing on edentulous ridges. Erythema multiforme is an acute self-limited disease that affects the skin and mucous membranes. The skin lesions are described as iris, target, or bull’s eye lesions. The mucosal lesions are superficial ulcerations.
The diagnosis of lichen planus is made on the basis of
A) clinical and radiographic appearance.
B) clinical and histologic appearance.
C) history of the condition.
D) therapeutic medication.
B) clinical and histologic appearance.
Diagnosis of lichen planus is made on the basis of clinical appearance and histologic findings of biopsy tissue. Radiographic findings do not contribute to the diagnosis of lichen planus. History of the condition is not definitive enough for the diagnosis of lichen planus. Topical and systemic corticosteroids have been used in the treatment of lichen planus but not to establish the diagnosis.
Which condition is not a component of Reiter syndrome?
A) Arthritis
B) Geographic tongue–like lesions
C) Urethritis
D) Wickham striae
D) Wickham striae
Wickham striae are associated with lichen planus. Arthritis is a component of Reiter syndrome. Oral mucosal lesions that resemble geographic tongue have been described in patients with Reiter syndrome. Urethritis is associated with Reiter syndrome.
An antigenic marker termed HLA-B27 is present in most patients with
A) lichen planus.
B) Reiter syndrome.
C) erythema multiforme.
D) Stevens–Johnson syndrome.
B) Reiter syndrome.
An antigenic marker called HLA-B27 is present in most patients with Reiter syndrome. Lichen planus is diagnosed through the clinical and histologic appearance of biopsy tissue. Erythema multiforme is thought to be a hypersensitivity reaction involving the skin and mucous membranes. Stevens–Johnson syndrome is the most severe form of erythema multiforme.
The acute disseminated form of Langerhans cell disease is termed
A) eosinophilic granuloma.
B) Hand–Schüller–Christian disease.
C) Letterer–Siwe disease.
D) Reiter syndrome.
C) Letterer–Siwe disease.
Letterer–Siwe disease is the acute disseminated form of Langerhans cell disease. Eosinophilic granuloma is a solitary or chronic localized form of Langerhans cell disease. Hand–Schüller–Christian disease is the chronic disseminated or multifocal form of Langerhans cell disease. Reiter syndrome is not a form of Langerhans cell disease.
Which form of Langerhans cell disease resembles lymphoma, affects children younger than age 3, and has a rapidly fatal course?
A) Letterer–Siwe disease
B) Hand–Schüller–Christian disease
C) Eosinophilic granuloma
D) Chronic localized form
A) Letterer–Siwe disease
Letterer–Siwe resembles lymphoma, affects children under 3 years, and has a rapidly fatal course. It is the most severe form of Langerhans cell disease. Hand–Schüller–Christian disease is the multifocal form of Langerhans cell disease. It occurs in children younger than 5 years. A classic triad is seen in 25% of patients. Eosinophilic granuloma affects older children and young adults. The chronic localized form is the same as eosinophilic granuloma.
The classic triad of symptoms seen in 25% of patients with Hand–Schüller–Christian disease includes all conditions except
A) well-defined or punched-out radiolucent areas in the skull.
B) exophthalmos.
C) cyclic neutropenia.
D) diabetes insipidus.
C) cyclic neutropenia.
Cyclic neutropenia is an inherited disorder characterized by a cyclic decrease in the number of circulating neutrophils. Aphthous ulcers, gingival recession, and alveolar bone loss can be seen in association with this systemic condition. Well-defined or punched-out radiolucent areas in the skull are part of the triad of symptoms in chronic disseminated Hand–Schüller–Christian disease. Exophthalmos is a part of the triad of symptoms in chronic disseminated Hand–Schüller–Christian disease. Diabetes insipidus is part of the triad of symptoms in chronic disseminated Hand–Schüller–Christian disease.
Sjögren syndrome is a(n)
A) autoimmune disease that affects the salivary and lacrimal glands.
B) allergic reaction.
C) form of aphthous ulcers.
D) type of Langerhans cell disease.
A) autoimmune disease that affects the salivary and lacrimal glands.
Sjögren syndrome is an autoimmune disease that affects the salivary and lacrimal glands. Sjögren syndrome is not an allergic reaction. Sjögren syndrome is not a form of aphthous ulcers. Sjögren syndrome is not a type of Langerhans cell disease.
The most common oral manifestation of Sjögren syndrome is
A) xerostomia.
B) xerophthalmia.
C) epimyoepithelial islands.
D) aphthous ulcers.
ANS: A
Xerostomia, or dry mouth, is the most common oral manifestation of Sjögren syndrome. Xerophthalmia is dry eyes caused by lack of lacrimal flow. Epimyoepithelial islands are seen histologically in Sjögren syndrome, but are not the most common oral manifestation. Aphthous ulcers are not associated with Sjögren syndrome, but are seen more commonly in Behçet syndrome, another autoimmune disease.
