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Dr. Murrahs class > Chapter 9: Allergies and Immunologic Diseases > Flashcards

Chapter 9: Allergies and Immunologic Diseases Flashcards

1
Q

___ is a common oral lesion; clinical alterations involve varialbe fungiform papilla and likely represents a hypersentivity or allergy

A

transient lingual papillitis

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2
Q

which type of transient lingual papillitis involves one to several fungiform papilla which become enlarged and are red or yellow, appear on the anteiror dorsal tongue, and are painful?

A

localized transient lingual papillitis

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3
Q

which type of transient lingual papillitis involves a large percentage of fungiform papilla which become enlarged and red, are located on the tip and lateral dorsal tongue, are very sensitive/painful, are associated with fever and lymphadenopathy, and can spread among family members?

A

generalized transient lingual papillitis

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4
Q

which type of transient lingual papillitis involves large number of affected papilla which appear as elevated, yellow or white papules, and is asymptomatic?

A

diffuse, papulokeratotic variant transient lingual papillitis

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5
Q

which type of transient lingual papillitis is associated with fever and lymphadenopathy?

A

generalized transient lingual papillitis

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6
Q

what is the treatment of transient lingual papillitis?

A

all 3 forms resolve without therapy

for symptomatic forms, topical steroids may reduce pain or duration

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7
Q
A

localized transient lingual papillitis

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8
Q
A

generalized transient lingual papillitis

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9
Q
A

diffuse, papulokeratotic variant transient lingual papillitis

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10
Q

recurrent aphthous ulcerations are also called ___

A

recurrent aphthous stomatitis

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11
Q

___ is one of the most common oral mucosal pathoses. what is the prevalence?

A

recurrent aphthous ulcerations

prevalence is about 30%

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12
Q

what is the etiology of recurrent aphthous ulcerations?

A

no universal etiology; seems to be an allergy or immune dysfunction of some sort

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13
Q

recurrent aphthous ulcers occur exclusively on what tissue?

A

movable mucosa

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14
Q

what are the 3 clinical variations of recurrent aphthous ulcers?

A
  • minor (85%)
  • major (10%)
  • herpetiform (5%)
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15
Q

recurrent aphthous ulcerations occur in what age patients?

A

first occurs in younger patients; 80% have their first ulceration before age 30

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16
Q
A

recurrent aphthous ulceration - minor

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17
Q

what is aphthous stomatitis?

A
  • major aphthae
    • suttons disease
    • adolescence
    • larger than 1cm
    • can take several weeks to heal
    • may cause scarring
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18
Q

which RAU form occurs in childhood?

A

minor

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19
Q

patients with which form of RAU have the fewest recurrences?

A

minor

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20
Q

which RAU lesions are shorter in duration than other variants?

A

minor

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21
Q

what form of RAU will patients typically have a prodrome?

A

minor

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22
Q

how do RAU minor lesions present?

A

erythematous macule followed by a central yellow-white, removable fibrinopurulent membrane

ulcerations are less than 1cm

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23
Q

which types of RAU do not cause scarring?

A

minor and herpetiform do NOT cause scarring

major MAY cause scarring

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24
Q

RAU minor lesions heal without scarring in what time frame?

A

1-2 weeks

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25
Q

there are typically ___ RAU minor lesions per episode

A

1-5

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26
Q

are RAU minor lesions more or less painful than they appear?

A

more

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27
Q

which RAU form occurs in adolescents?

A

major

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28
Q
A

RAU major

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29
Q

are RAU major lesions larger or smaller than minor aphthae?

A

larger

measure about 1-3cm in diameter

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30
Q

which RAU type demonstrates the longest duration per episode when compared to other variants, and what is the time frame?

A

major, takes 2-6 weeks to heal

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31
Q

how many lesions per episode occur with RAU major?

A

1-10

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32
Q

what tissues are most commonly involved in RAU major aphthae?

A

labial mucosa, soft palate, tonsillar fauces

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33
Q
A

RAU herpetiform

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34
Q

which RAU form occurs most commonly in adults?

A

herpetiform

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35
Q

of the three RAU types, which one has the greatest number of lesions and recurrences?

A
  • herpetiform
  • can have up to 100 ulcerations per occurrance
  • may have continuous lesions for 3 years
  • recurrences are closely spaced
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36
Q

what is the size of RAU herpetiform lesions?

A

smallest of the 3 variants - 1-3mm in diameter

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37
Q

RAU herpetiform lesions heal in what time frame?

A

7-10 days

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38
Q

RAU herpetiform aphthae is more common in males or females?

A

females

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39
Q

what is the general size, healing time, scarring, lesions/episode, and recurrence of RAU minor?

A
  • general size - 3-10mm
  • healing time - 7-14d
  • scarring - no
  • lesions/episode - 1-5
  • recurrence - fewest
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40
Q

what is the general size, healing time, scarring, lesions/episode, and recurrence of RAU major?

A
  • general size - 1-3cm
  • healing time - 2-6w
  • scarring - possible
  • lesions/episode - 1-10
  • recurrence - more than minor, less than herpetiform
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41
Q

what is the general size, healing time, scarring, lesions/episode, and recurrence of RAU herpetiform?

A
  • general size - 1-3mm (smallest)
  • healing time - 7-10d
  • scarring - no
  • lesions/episode - up to 100
  • recurrence - most
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42
Q

what is the treatment for RAU minor?

A

no treatment or OTC treatment

43
Q

when is it appropriate to prescribe a topical corticosteroid for the treatment of RAU?

A
  • if patient presents with multiple recurrences, many lesions, or intense pain
  • 0.05% clobetasol proprionate, dispense 15mg, instruct to dry the affected area and apply a thin amount 2x/day as needed
    • this is a potent steroid so re-emphasize that a little goes a long way
44
Q

___ is a chronic, recurrent immune mediated disease with oral aphthous-like ulcerations, ocular inflammation, genital ulcers, and skin lesions

A

behcet’s syndrome

(will not be testing on pictures)

45
Q

___ is a common complaint in pateints with behcet’s syndrome

A

joint pain - arthralgia, enlarged joints

46
Q

what is the treatment of behcet’s syndrome?

A

systemic and topical steroids

47
Q

___ is a multisystem granulomatous disorder of unknown cause

A

sarcoidosis

48
Q

of african americans and caucasians, which population is sarcoidosis more prevalent?

A

african americans

49
Q

what organs are most commonly involved in cases of sarcoidosis?

A

lungs, lymph nodes, skin, salivary glands, eyes

50
Q

___ tissue is involved in almost all cases of sarcoidosis

A

lymphoid

51
Q

90% of sarcoidosis cases will show abnormal ___

A

chest xray

52
Q

what do the skin lesions look like in sarcoidosis patients? what percent of patients with sarcoidosis have skin lesions?

A
  • chronic, purple, indurated lesions on head and neck, termed lupus pernio
  • scattered, nonspecific, tender, red nodules on lower legs termed erythema nodosum
  • 25% of patients
53
Q

what are the 2 different syndrome associated with acute sarcoidosis?

A
  • lofgren’s syndrome
  • heerfordt’s syndrome (uveoparotid fever)
54
Q
A

sarcoidosis

55
Q

what are characteristics of lofgren’s syndrome?

A
  • erythema nodosa
  • bilateral hilar lymphadenopathy
  • arthralgia
56
Q

what are characteristics of heerfordt’s syndrome?

A
  • parotid enlargement
  • inflammation of the eye
  • facial paralysis
  • fever
57
Q

what are the histological featuers of sarcoidosis?

A
  • granulomatous inflammation
  • schaumann bodies (degenerated lysosomes)
  • asteroid bodies (entrapped collagen fragments)
  • hamazaki-wesenberg bodies (large lysosomes)
58
Q

how is sarcoidosis diagnosed?

A
  • elevated serum angiotensin-converting enzyme levels
  • chest xray
  • kveim test - no longer used
59
Q

what is the treatment/prognosis of sarcoidosis?

A
  • 60% - symptoms resolve spontaneously in 2 years
  • corticosteroids if patients have progressive disease
  • 5-10% succomb to disease
60
Q

what is the presentation of orofacial granulamotosis?

A

it is variable, but the lips are most commonly involved

61
Q

describe lip involvment with orofacial granulomatosa

A
  • labial tissue presents as a non-tender, persistent swelling
  • when lips are only involved, it is termed cheilitis granulomatosa
62
Q

melkersson-rosenthal syndrome is a form of ___

A

orofacial granulomatosis

63
Q

what are the 3 characteristics of melkersson-rosenthal syndrome?

A
  • cheilitis granulomatosa
  • facial paralysis
  • fissured tongue
64
Q

the histology of orofacial granulomatosa is ___

A

granulomatous inflammation

65
Q

in order to diagnose orofacial granulomatosis, other diseases causing granulomatous inflammation should be ruled out, such as ___

A

sarcoidosis and TB

66
Q

only lips are involved

A

cheilitis granulomatosa (a form of orofacial granulomatosis)

67
Q

patient also has facial paralysis

A

melkersson-rosenthal syndrome

68
Q
A

orofacial granulomatosis

69
Q
A

wegener’s granulomatosis

70
Q
A

wegeners granulomatosis

71
Q

is wegeners granulomatosis more common in males or females? what is the average age patient who is affected?

A
  • male and female prevalence is equal
  • average age is 40
72
Q

___ is characterized by necrotizing granulomatous lesions of the respiratory tract, with necrotizing glomerulonephritis and systemic vasculitis of small arteries and veins

A

classic wegener’s granulomatosis

73
Q

what can happen if wegener’s granulomatosis is untreated?

A
  • rapid renal involvement develops
  • renal involvement is the most common cause of death
74
Q

what is limited wegener’s granulomatosis?

A

upper respiratory system, no renal lesions

75
Q

what is superficial wegener’s granulomatosis?

A

lesions occur primarily on skin and mucosa

76
Q

visible lesions of wegener’s granulomatosa may appear as ___

A

nonspecific ulcerations

77
Q

___ lesions are characteristics of wegener’s granulomatosis

A

oral

78
Q

what are the oral lesions that are characteristic of wegener’s granulomatosis?

A
  • strawberry gingivitis
    • typically an early manifestation
    • affected gingiva demonstrates a florid, erythematous, granular hyperplasia
79
Q

how is wegener’s granulomatosis diagnosed?

A
  • indirect immunofluorescence detects presence of antineutrophil cytoplasm antibodies (ANCA)
    • perinuclear (p-ANCA)
    • cytoplasmic (c-ANCA) - most useful
80
Q

what is the treatment/prognosis for classic wegener’s granulomatosis?

A
  • untreated = 10% two year survival
  • steroids are first-line tx; 75% survive
  • 30% relapse
  • cure can be attained if caught early and appropriately treated
81
Q

concentrations of cinnamon flavoring is ___x that in the natural spice, and can cause ___

A
  • 100x
  • contact stomatitis
82
Q

reactions with cinnamon flavoring are most common in products associated with prolonged/frequent contact, including what 3 products?

A

candy, chewing gum, toothpaste

83
Q

clinical presentation of contact stomatitis from cinnamon varies according to ___

A

delivery medium

  • toothpaste = diffuse
  • gum/candy = localized
84
Q

___ can cause the gingiva to appear large and red, and superficial soughing can occur (much like that seen in patients using sodium lauryl sulfate-containing toothpastes)

A

contact stomatitis from cinnamon

85
Q

localized contact stomatitis from cinnamon lesions can appear ___

A

ulcerated, white, or red

86
Q

signs and symptoms of contact stomatitis from cinnamon disappear within what time frame of discontinuation of cinnamon product?

A

1 week

87
Q

angioedema is also called ___

A

quincke’s disease

88
Q

___ causes diffuse edemetous swelling of the soft tissues

A

angioedema

89
Q
A

contact stomatitis from cinnamon flavoring

90
Q
A

contact stomatitis from cinnamon flavoring

91
Q
A

contact stomatitis from cinnamon flavoring

92
Q
A

angioedema

93
Q

is there pain associated with angioedema?

A

no, but itching and erythema can be present

94
Q

what is the most common cause of angioedema?

A
  • mast cell degranulation, which leads to histamine release
    • IgE-mediated hypersensitivity reactions
95
Q

angioedema occurs most commonly on the ___

A

extremeties

96
Q

angioedema resolves after how long?

A

1-2 days

97
Q

what is the treatment for allergic angioedema?

A
  • oral antihistamine therapy
    • IM epinephrine or IV corticosteroids in severe cases
98
Q

cases of angioedema that include diffuse involvement of the head and neck can be caused by ___

A
  • angiotensin-converting enzyme inhibitors
    • -prils (such as lisinopril) - medication for HTN or chronic heart failure
99
Q

what population is angioedema most common in?

A

african americans

4x more common than in caucasians

100
Q

what health care provider most commonly sees ACE inhibitor-associated angioedema?

A

oral health care practitioners

101
Q

swelling associated with ACE inhibitor drugs does not respond well to ___

A

antihistamines

102
Q

what is the treatment for ACE inhibitor-associated angioedema?

A
  • avoid all medications in this class of drugs
  • monitor until swelling subsides
  • some respond well to C1-INH concentrate
103
Q

what are the two types of angioedema?

A

allergic angioedema and ACE inhibitor-associated angioedema

Dr. Murrahs class (17 decks)

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