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Oral Pathology Test 1 > Week 2 > Flashcards

Week 2 Flashcards

1
Q

Types of Pemphigus (4)

-2 ways to GENERALLY differentiate the types (not specifics)

A

1/2. Vulgaris and Vegetans
3/4. Foliaceus and erythematous
-Generally separate via distinc CLINICAL and MICROSCOPIC presentations.

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2
Q

Which types of pemphigus affect entire epithelium? (2)

Which types affect only upper prickle cell/spinous layer? (2)

A

Entire epithelium: V! Vulgaris and Vegetans

Prickle/spinous cell: EF! Erythematous and Foliaceus

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3
Q 
Review of the hypersensitivities
Type I
II
III
IV
A
  1. Immediate
  2. Antibody/antigen AT cells
  3. Antibody/Antigen in BLOOD (circulating)
  4. SLOW reaction
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4
Q

What type of ACANTHOSIS is Pemphigus?

  • primary or secondary?
  • -Example of the other type?
A

Pemphigus directly attacks the attachment btwn cells
-THUS it is PRIMARY

HSV causes ballooning of the cells and THEN they cause acanthosis
-THUS it is SECONDARY

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5
Q

THIS IS THE ONE THING YOU NEED TO ASSOCIATE WITH PEMPHIGUS FOR BOARDS AND PATH TESTS!

A

The affected protein is: Desmoglein 3!

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6
Q

Definition of acantholysis?

A

Loss of intercellular adhesion (proteins)

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7
Q

Strength of Pemphigus Bulla/vesicles?

-Because?

A

WEAK because they are loss of attachment WITHIN the epithelium.

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8
Q

Pemphigus
DECADE of life
M vs F Ratio?
race differences?

A

Decade 4th to 5th
M = Female
Ashkenazi Jews

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9
Q

Pemphigus
HLA Phenotypes affected?
-Pneumonic

A

Dr. 10 dribbles

HLA-DR
HLA-A10
HLA-DRB1

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10
Q

What other diseases are associated with Pemphigus? (5)

-what do they have in common?

A

They are all autoimmune

  • myashenia gravis
  • SLE
  • RA
  • Hashimoto Thyroiditis
  • Sjogrens syndrome (venus williams)
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11
Q

Oral lesions of pemphigus look like what other 2 diseases?

A

Erythema Multiforme

HSV

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12
Q

What % of cases have oral lesions that PRECEDE other cutaneous lesions for pemphigus?

A

60%

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13
Q

Clinical features of pemphigus 4

A

Oral lesions
**Nikolsky Sign!
Generalized Bulla/vesicles CHRONICALLY!

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14
Q

4 differentials for Pemphigus?

A

MMP
Erythema Multi
Aphthous ulcers
Paraneoplastic pemphigus

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15
Q

What differenciates MMP from Pemphigus (4)

A
  1. Laminin 5 and BP 180 kd NOT Desmoglein 3
  2. MMP has occular tissue
  3. MMP has Low circulating Antibodies
  4. MMP effects the BMZ
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16
Q

Differences btwn EM and Pemphigus? (3) 1 main one

A

Target lesions, very acute, etc.

-Type 3 hypersensitivity (EM) not 2

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17
Q

Differences btwn Aphthous ulcers and pemphigus?

A

Unknown etiology for aphthous ulcers

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18
Q

Difference for paraneoplastic pemphigus and pemphigus?

A 
#1 History of Cancer
2. Large variety of antibodies
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19
Q

Histopath of pemphigus?

A
  1. Intraepithelial clefting (indicates acantholysis)
  2. Tiny Tzank cells (collapsing)
  3. Basement membrane is intact (loss is within the epithelial layer.
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20
Q

Pathognomic is what?

A

A characteristic difference only found in one disease!

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21
Q

3 immunologic Vesiculo-bullous (ulcerative) diseases

A
  1. Pemphigus Vulgaris PV. 2. Mucous membrane Pemphigoid ((B)MMP) benign. 3. Bullous Pemphigoid
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22
Q

Is the most inferior layer of the epithelium attached to the basement membrane in pemphigus? in a histologic slide

A

yes, yes it is

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23
Q

Do you use a direct or indirect study on pemphigus?

What 3 antibodies are you looking for?

A

Direct

looking for IgG, IgA, and C3.

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24
Q

Treatment for pemphigus

  • If Skin and mouth=
  • If just mouth=
A

If both, send to dermatologist and they prescribe: monoclonal antibodies (Embrel, etc)

If just mouth then topical steroids!

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25
Q

Characteristics of MMP

  • Antigens affected (2)
  • Antigen levels?
  • Tissues affected (2)
A
  • Antigens: BP 180 kd and Laminin 5
  • Low levels of circulating antibodies
  • Tissues affected: Eyes and Oral (skin)
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26
Q

Characteristics of MMP

  • Age
  • Sex ratio
  • Pain?
A

Age is Adult…

  • More women than men!
  • Mild to moderate discomfort
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27
Q

Characteristics of MMP

Oral lesions ARE (4)

A
  • RED
  • ATTACHED gingiva
  • Rarely Bullae (vesicles)
  • Also rupture easily, but thicker than Pemphigus
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28
Q 
Characteristics of MMP
Occular lesions (3)
A
  • Scarring of canthus
  • inverted lashes
  • Cornea trauma (blindness)
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29
Q

Characteristics of MMP

Will they be positive for Nikolsky’s Sign?

A

YES

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30
Q

Characteristics of MMP

Histopathology

A

Subepithelial clefting!

basal layer lifts from BMZ

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31
Q

Immunoflourescent testing has two types what are they?

A

Direct and indirect

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32
Q

Direct definition

A

Requires Biopsy/Patients tissue

-exposed to antibodies labeled with fluorescence.

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33
Q

Indirect definition

A

Take patients blood (use the serum) and tag it with the color and place that on a different host’s tissue (rat bladder)

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34
Q

Which diseases use Direct fluoroscopy? (2)

A

Pemphigus Vulgaris

MMP

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35
Q

Which disease uses Indirect?

A

Paraneoplastic pemphigus (many different antibodies looked for)

**NOT for MMP, it has LOW circulating antibodies

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36
Q

5 Differentials for MMP

Pneumonic

A
  1. Pemphigus V
  2. Lichen planus
  3. Linear IgA
  4. Discoid Lupus erythematosus
  5. Lichenoid mucous
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37
Q

5 Differentials for MMP

How to differenciate?

A

Take biopsy and Direct Immunofluorescent test!

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38
Q

5 Differentials for MMP

Why not Linear IgA?

A

There is an IgA linear border at the BMZ

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39
Q

5 Differentials for MMP

Discoid Lupus, what is the diff?

A

Butterfly rash on malar bones

40
Q

Treatment for MMP,

what is the cure?

A

THERE IS NO CURE!!!!! only managed

41
Q

Treatment for MMP
Refer to (2)
Treatment (3)

A

Refer to rheumatologist AND ophthalmologist.

Treat with: steroids, Tetracycline w/ niacinamide, and Monoclonal Antibodies.

42
Q 
Bullous Pemphigoid
characteristics
-Age
-Antibodies types
-Antibody levels
A

Age 70-80
Antibody types: Laminin, BP 180 kd, AND BP 230 kd.
Antibody levels: High enough for an indirect test.

43
Q

BP
Characteristics
-lesion location (2)

A
  1. Skin
  2. Oral
    NOT EYES NOT EYES!
    MMP has eye involvement
44
Q

Epidermolysis Bullosa

Types 2

A

Acquired

Hereditary/Genetic = Dystrophic

45
Q 
EB
aquired form characteristics
-A.K.A. 
-Antibodies (2)
-How it is acquired?
A

Aka-epidermolysis acquisita
Antibodies: IgG @ BMZ, and Type VII collagen BELOW Lamina densa
-Acquired via drugs

46
Q

EB
Genetic/hereditary/Dystrophic/junctional/simplex
-TWO characteristics

A

Enamel pitting

No circulating antibodies! (no indirect testing allowed)

47
Q

EB

Clinical findings Oral: (3)

A
  1. Scarring bulla
  2. Hypoplastic TEETH
  3. Limited mouth openin (due to scarring)
48
Q

EB clinical findings (non-oral)

2

A
  1. Bulla formation from
    - trauma
    - Stress
  2. Dystrophic Nail beds
49
Q

Treating EB (2)

A
  • Steroids

- Vitamin E

50
Q

Ulcerative Conditions

-Definition of ulcer

A

-Discontinuation of the epithelium DUE TO death of cells

51
Q

Ulcerative conditions

-Key trait of malignant ulcers?

A

PAINLESS! very important for early detection

52
Q

Ulcerative conditions

-Key characteristic of self-mutilating ulcers

A

Linear ulceration with chosen traumatic instrument

53
Q

Where do you find traumatic ulcers most and 2nd most often?

A
  1. Tongue - DRINKS

2. Hard Palate - PIZZA BURN

54
Q

FACTITIAL INJURY means what?

A

Self induced

55
Q

Clinical features of Traumatic Ulcers (TU)

  • Acute vs Chronic (2)
  • —Pain, Margin,
A

Acute Pain- Painful
Chronic Pain - No pain

Acute Margin - “yellow base” Red margin
Chronic margin - “yellow base” White margin

56
Q

Four types of Acute ulcers

A

Thermal chemical mechanical aphthous

57
Q

The ONE thing ALWAYS on your list of differentials, if a chronic ulcer presents?

A

SCC

-Squamous cell carcinoma

58
Q

What type of necrosis will happen from topical aspirin?

A

Coagulative

59
Q

What causes most chemical ulcerations?

A

H2O2 (teeth bleaching)

60
Q

WHere do you find radiation ulcers vs chemo ulcers?

A

Radiation is at the therapy location

Chemo can be found anywhere!

61
Q

Histopathology of Trauma ulcers (2)

A

Fibrinous exudate

Fibrin network with PMN’s

62
Q

What does TUGSE stand for?

A

Traumatic Ulcerative Granuloma w/ stromal eosinophilia

63
Q

histopathology of TUGSE what cells are found? (5)

A
    1. Eosinophils (in C.T.)
    1. Lymphocytes (this is a more chronic ulcer)
      1. Nphil
      2. Macrophage
      3. Plasma cells
64
Q

Recall time for an ulcer (concern about it being chronic?)

A

2 WEEKS

65
Q

Bacteria that causes Syphilis

A

Treponema Pallidum

66
Q

What Symptom is seen in Syphilis?

-Primary

A

Chancre

-Ulcer AT SITE OF Infectious transfer

67
Q

What Symptom is seen in Syphilis?

-Secondary (3)

A

NOT ULCERS

  • Mucous patches
  • Condyloma Latum
  • Maculopapular Rash
68
Q

What Symptom is seen in Syphilis?

-Tertiary (3) Neurosyphilis and Cardiovascular

A
  • Gumma
  • Mucosal Atrophy
  • Palatal Perforation
69
Q

Definition of Granuloma (5)

A

Collection of epitheliod Macrophages

  • Lymphocytes
  • Histocytes
  • Foreign Body Giant cells OR Langerhans Giant cells (horseshoe shape)
  • —Necrosis in the center
70
Q

symptoms of congenital Syphilis (4)

A

HUTCHINSON TRIAD

  1. Interstitial keratitis
  2. VIII deafness
  3. TAPERING Incisors
  4. Mulberry molars
71
Q

Histopathology of Primary and Secondary Syphilis (2)

A

Proliferative endarteritis

*Plasma cells

72
Q

Proliferative endarteritis is what?

A

Inflammation around B.V.

-Causing proliferation of tunica Intima and occluding the vessels.

73
Q

What is a Gumma? (2)

A

Granulomatous lesions

-Necrosis

74
Q

Differentials of Primary Syphilis (2)

A 
SCC
Chronic ulcers (traumatic, i guess...)
75
Q

Differential for secondary syphilis? *****

A

NOT ULCERS

76
Q

Differential for tertiary syph? (5)

A
  1. T-Cell Lymphoma
  2. Deep fungal infection
  3. Salivary gland neoplasm
  4. Scc
  5. Cocaine
77
Q

Treatment for Syph?

A

Penicillin G

78
Q

What (via a Serological test) may we get a pos. rxn for syph?

A

SLE.

79
Q

Gonorrhea what symptoms?(2)

A

Pharyngeal ulcerations

-Cervical lymphadenopathy

80
Q

Differential for Gonorrhea (4)

A

Aphthous ulcer
Herpetic ulcers
Streptococcal infection
EM

81
Q

TB bacteria

A

Mycobacterium Tuberculosis

82
Q

Spread via (2)

A

AIRBORNE

-Implantation in any cuts or openings in your mouth

83
Q

****The bacteria does not cause the lesions, it is caused by the bodies reaction (type 4 HS) and inability to eradicate the Bugs

A

BLANK

84
Q

Histopathology of TB (2)

A

Caseous Necrosis

-Granulomas

85
Q

Actinomycosis

  • Gram
  • Aerobicity?
A

Gram pos

Anaerobic

86
Q

Actinomycosis

-Is this always a pathogen?

A

NOPE

-commensalism organism

87
Q

Actinomycosis

-Symptoms (3)

A
  1. Numbs lip (swelling)
  2. Painful (swelling) Osteomyelitis
  3. Fistula (Sulfur granules, colored by CFU)
88
Q

Actinomycosis

-4 things cause numbness DIFFERENTIAL

A
  1. Stroke
  2. Trauma
  3. Tumor
  4. Osteomyelitis
89
Q

Actinomycosis

- Two other microbes that cause osteomyleitis?

A

Bact - TB / Staph

(fungal can cause it too)

90
Q

Actinomycosis treatment

A

Penicillin

91
Q

Actinomycosis Histopath (2)

A

Bacterial colonies
—w/ Nphils

Granulation tissue (chronic lesion)

92
Q

What carries histoplasmosis (source)

A

FLYING POOPERS

-pigeons and Bats

93
Q

Symptoms of Deep fungal infections (4)

A 
Lung invoved
-Chronic ulcer
-Undermined border
***Peripherally LUMPY
(Looks like malignancy)
94
Q

Who do you find fungal infections in? (2)

A

Immunosuppressed (including diabetics)

95
Q

4 Differentials for Deep fungal

A
  1. Traumatic ulcers
  2. TB (oral lesions)
  3. Primary Syph
  4. SCC
96
Q

Histopath (2) deep fungal

A
  1. Fake epithelial hyperplasia

2. Granuloma

97
Q

People who get Opportunistic fungal infections

always found on the body

A
  1. Diabetic
  2. Malignancies (adv.)
  3. Radiation
  4. Immunosuppressed

Oral Pathology Test 1 (4 decks)

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