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4th yr- CMS- The Oral Cavity > immune mediated disease > Flashcards

immune mediated disease Flashcards

1
Q

What are hypersensitivity reactions divided into

A

4 types

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2
Q

What is a type I hypersensitivity reaction called

A

Immediate/ Anaphylactoid

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3
Q

What is a type I hypersensitivity mediated by

A

IgE mediated mast cell degranulation

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4
Q

Give examples of type I hypersensitivity

A
  1. Hay fever

2. Anaphylaxis to insect stings or medications like penicillins

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5
Q

What is a type II hypersensitivity reaction called

A

Antibody mediated Cytotoxicity

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6
Q

What is a type II hypersensitivity mediated by

A

Circulating antibodies that activate complement

IgG

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7
Q

Give examples of type II hypersensitivity

A
  1. pemphigus vulgaris,
  2. mucous membrane pemphigoid,
  3. haemolytic anaemia
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8
Q

What is a type III hypersensitivity reaction called

A

Immune complex mediated

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9
Q

What is a type III hypersensitivity mediated by

A

Antibody complexed with antigen circulating the vasculature

IgG

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10
Q

What is a type IV hypersensitivity reaction called

A

Delayed hypersensitivity reaction

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11
Q

What is a type IV hypersensitivity mediated by

A

T cell mediated

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12
Q

Give examples of type IV hypersensitivity

A
  1. Health care workers hand dermatitis

2. Contact chelitis

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13
Q

What is autoimmunity

A

Reaction of the body against itself

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14
Q

What is autoimmunity referred as

A

Loss of self tolerance

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15
Q

Who is more affected by autoimmune disease men or women

A

Females more than males

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16
Q

How many people are affected by autoimmune disease

A

1 in 20-30

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17
Q

Name the 2 forms of lupus

A
  1. Systemic lupus Erythematosis (SLE)

2. Discoid lupus Erythematosis (DLE)

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18
Q

What does systemic lupus Erythematosis affect

A

Affects a wide range of organs

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19
Q

What can systemic lupus Erythematosis cause

A

morbidity and mortality

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20
Q

What is Discoid Lupus Erythematosis

A

Is lupus of the cutaneous and mucosa surfaces

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21
Q

Which type of lupus has a higher morbidity

A

Systemic Lupus Erythematosis

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22
Q

What is systemic lupus Erythematosis

A

A chronic inflammatory autoimmune disease of unknown cause

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23
Q

In whim is systemic lupus Erythematosis more common in men or women

A

Women (90%)

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24
Q

What can systemic lupus Erythematosis be due to

A
  1. Genetic predisposition

2. Environmental triggers

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25
Q

What autoantibodies can form in a patient with systemic lupus Erythematosis

A 
DNA
RNA
nucleoproteins
Cytoplasmic components 
Cell surface antigens
ECM components
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26
Q

How does mild systemic lupus Erythematosis

A

Skin rashes plus arthritis

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27
Q

How does severe systemic lupus Erythematosis present

A
  1. Renal impairment/ failure (lupus nephritis)
  2. Serious infections
  3. Accelerated atherosclerosis
  4. Thrombotic events
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28
Q

What is the cause of death of systemic lupus Erythematosis patients

A

Severe active lupus early on
OR
May be due to sequelae such as the accelerated atheroma causing stroked and myocardial infarction

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29
Q

What organs can be affected by systemic lupus Erythematosis

A
  1. Constitutional
  2. Musculoskeletal system
  3. Mucocutaneous
  4. Renal
  5. CVS system
  6. Respiratory system
  7. CNS
  8. Gastrointestinal
  9. Haematological
  10. Reticuloendothelial
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30
Q

How can systemic lupus Erythematosis affecting constitutional organs present

A

Fatigue

Fever

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31
Q

How can systemic lupus Erythematosis affecting musculoskeletal systems present

A
  1. Arthralgia
  2. Non erosive poly arthritis
  3. Raynaud’s phenomen
  4. Osteoporosis
  5. Secondary sjögrens syndorme
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32
Q

How can systemic lupus Erythematosis affecting mucocutanous organs present

A
  1. Malar rash (aka butterfly rash) across cheeks and bridge nose pathognomic of SLE
  2. Photosensitivity rashes
  3. Urticaria
  4. Vasculitic rashes
  5. Lichenoid lesion intra orally
  6. Non specific oral ulcerations
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33
Q

How can systemic lupus Erythematosis affecting renal organs present

A

Renal impairment and failure due to nephritis or other pathologies

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34
Q

How can systemic lupus Erythematosis affecting the CNS system present

A
  1. Mood disorders
  2. Psychoses
  3. Cerebrovascular disease
  4. Seizures
  5. Headaches
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35
Q

How can systemic lupus Erythematosis affecting the cardiovascular system present

A
  1. Pericarditis
  2. Endocarditis
  3. Ischaemic heart disease
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36
Q

How can systemic lupus Erythematosis affecting the respiratory system present

A

Pleaural effusions

Fibrosing alveolitis

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37
Q

How can systemic lupus Erythematosis affecting the Gastrointestinal system present

A

Anorexia

Nausea and vomiting

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38
Q

How can systemic lupus Haematological affecting the Gastrointestinal system present

A

Anaemia
Thrombocytopenia
Leukopenia

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39
Q

How can systemic lupus Erythematosis affecting the Reticuloendothelial system present

A

Lymphoedenopathy

Hepatomegaly

40
Q

What guide the treatment of systemic lupus Erythematosis

A

symptoms guide treatment

41
Q

What is the aim of systemic lupus Erythematosis management

A

Reduce morbidity and improve quality of life

42
Q

What medication can we prescribe systemic lupus Erythematosis patients

A
  1. NSAIDS and aspirin
  2. Anti-coagulants
  3. Anti-malarial agents
  4. Corticosteroids and immunomodulators
  5. Biologics
  6. IV immunoglobulin and plasmapheresis
43
Q

What is discoid lupus eryrhematosis

A

A limited variant or lupus restricter to the skin and mucous membrane

44
Q

How does discoid lupus eryrhematosis present on the skin

A

Well demarcated raised, white, scaly plaques with varying degrees of erythema that do not typically itch

45
Q

How does discoid lupus eryrhematosis present in the mucosa

A

May closely resemble oral lichen planus clinically and histopathologically has a predilection for the hard palate which is an uncommon site to be affected by idiopathic OLP
may also affect the lips including the vermilion border

46
Q

When can discoid lupus eryrhematosis flare up

A

Can flare up dramatically in the sun

47
Q

If discoid lupus eryrhematosis is seen in the mouth what can that mean

A

Potentially malignant

48
Q

If you suspect a patietn has lupus what should you as a dentist do

A
  1. Is it systemic or limited/ discoid
  2. Find out if the patient has had any complication
  3. Take a careful drug history
  4. Find out current and past disease status
49
Q

What is rheumatoid arthritis

A

Is a multi system inflammatory disease which typically targets the small joins

50
Q

How common is rheumatoid arthritis

A

Affects 1% of the population

51
Q

Does rheumatoid arthritis affect men or women more

A

Women more (75%)

52
Q

List some of the non articular involvements of rheumatoid arthritis

A
  1. Lethargy, malaise, depression
  2. Anaemia
  3. Generalsed lymphadenopathy
  4. Pulmonary and cutaneous nodule development
  5. Pericardial effusions, mitral regurgitation
  6. Raynaud’s phenomenon
  7. Sjögren’s syndrome
53
Q

What criteria do we use to aid the diagnosis of rheumatoid arthritis

A
  1. Early morning stiffness
  2. Inflammatory arthritis of 3 or more defined joint areas
  3. Inflammatory arthritis
  4. rheumatoid nodules
  5. Radiography/ ultrasons evidence of synovitis and joint destruction
54
Q

What medication do we use to manage rheumatoid arthritis

A
  1. NSAIDs
  2. DMARDs
  3. Corticosteroids
  4. Biologics
55
Q

What is the last joint to be affected in rheumatoid arthritis

56
Q

What is autoimmune thyroid disease an example of

A

Organ specific autoimmune disease

57
Q

What do patients with thyroid disease go through

A

thyroid spectrum’ and go from hypo- to eu- to hyper- thyroid status or vice versa (but not necessarily so)

58
Q

What is hypo thyroid disease

A

Un reactive thyroid

59
Q

What is EU thyroid disease

A

Normal thyroid function

60
Q

What is hyper thyroid disease

A

Over reactive thyroid

61
Q

What does the thyroid do

A

It is a big player in maintaining homeostasis through the production of and actions of the carious hormones it produces

62
Q

How does the thyroid affect basal metabolic activity

A
  1. Increases basal metabolic rate
  2. increases body temperature
  3. Increases appetite
63
Q

How does the thyroid affect CHO, lipid and protein metabolism

A
  1. Promotes glucose catabolism to release energy
  2. Stimulates protein synthesis
  3. Increases lipolysis
  4. Enhances cholesterol excretion in bile
64
Q

How does the thyroid affect cardiovascular system

A
  1. Promotes normal cardiac function

2. Controls heart rate and strength of the pulse

65
Q

How does the thyroid affect the nervous system

A
  1. Promotes normal neuronal development in foetus and infant
  2. Promotes normal neuronal in adults
  3. Enhances effects of sympathetic nervous system
66
Q

How does the thyroid affect the Musculoskeletal system

A
  1. Promotes normal body growth and maturation o f the skeleton
  2. Promotes normal function and development of muscles
67
Q

How does the thyroid affect the reproductive system

A

Promotes normal female reproductive ability and lactation

68
Q

Give an example of autoimmune hyperthyroidism

A

Graves disease

69
Q

What is Graves disease the most common cause of

A

Hyperthyroidism

70
Q

How common is graves disease in women and men

A

Affects 1% of females

Affects 0.1% of men

71
Q

What happens in graves disease

A

Autoantibodies are produced versus TSH receptors on the surface of the thyroid

72
Q

What happens if Autoantibodies are produced versus TSH receptors on the surface of the thyroid

A
  1. The gland is therefore OVER stimulated
  2. Means that MORE T3 and T4 are produced
  3. The negative feedback loop does not function
73
Q

What are the classic symptoms of graves disease

A
  1. Weight loss
  2. Heat tolerance
  3. Fatigue and weakness
  4. Hyperactivity
  5. Irritability
  6. Insomnia
  7. Tremors
  8. Warm moist skin
  9. Hair loss
  10. Tachycardia
74
Q

Other than the common symptoms what else is characteristically seen in graves disease

A
  1. Pre-tibial myoxedema
  2. Vitiligo
  3. Pernicious anaemia
  4. Type 1 diavetes mellitus
  5. Psychosis
  6. Graves eye disease
75
Q

What is Pre-tibial myoxedema

A

Swollen lumpy appearance over the skins of the lower legs or feet

76
Q

What is Vitiligo

A

autoimmune patchy depigmentation of the skin due to destruction of the body’s own melanocytes

77
Q

How does graves eye disease manifest

A 
1. Proptosis and exophthalmos
2Ophthalmoplegia
3. Diplopia
4. Blurred vision 
5. Conjunctival inflammation 
6. Increased tear production
78
Q

What is Ophthalmoplegia

A

Restricted eye movements due to hypertrophied extra ocular eye muscles occupying a greater amount of the orbit pushing the glove of the eye forward

79
Q

What is Diplopia

A

Double vision

80
Q

What is the aim of initial graves disease treatment

A

To make the patient euthyroid once again and therefor reduce/ eliminate symptoms

81
Q

How do we manage graves disease initially

A
  1. Anti-thyroid drugs
  2. Beta blockers
  3. Radioactive iodide treatment
82
Q

After initial treatment how might we manage graves disease

A

Surgery may be undertaken to reduce/ remove the goitre

83
Q

What is hypothyroidism due to

A

A lack of T3 and t5

84
Q

What are the causes of hypothyroidism

A
  1. Hashimoto’s thyroiditis
  2. Idiopathic atrophy
  3. Treatment for hyperthyroidism
  4. Medications such as amiodarone or lithium
  5. Iodine deficiency
  6. Congenital hypothyroidism
85
Q

How common is congenital hypothyroidism

A

Affects 1 in 4000 births

86
Q

How common is hypothyroidism in men and women

A

AFFECTS 15 per 1000 females

Affects 1 in 1000 males

87
Q

What are the common symptoms of hypothyroidism

A
  1. Lethargy
  2. Weight gain
  3. Depression
  4. Cold intolerance
  5. Goitre
  6. Cold dry skin
  7. Bradycardia
  8. Arthralgia and myalgia
88
Q

Give an example of hypothyroidism

A

Hashimotos thyroiditis

89
Q

What happens in Hashimotos thyroiditis

A

Autoimmune destruction of the thyroid by the lymphocytes

90
Q

How do we manage Hashimotos thyroiditis

A

Replacement thyroid hormones

91
Q

What do we need to monitor in patients with Hashimotos thyroiditis

A

Thyroid function tests monitored 6-12 months

92
Q

What is lingual thyroid

A

An uncommon finding of an ectopic thyroid gland on the posterior dorsal of the tongue at the caecum

93
Q

What is lingual thyroid associated with

A

70% of hypothyroidism cases

Associated with cretinism

94
Q

What can a Large ectopic lingual thyroids impair

A

Speech and swelling

95
Q

Thyroid cancer accounts for how many cancers annually

4th yr- CMS- The Oral Cavity (6 decks)

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