Deck 3: Immunity and Immunologic Oral Lesions

Question 1

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.

Answer 1

lichen planus.

Question 2

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

Answer 2

Humoral immunity

Question 3

The breakdown of cellular adhesion between epithelial cells is called:

A)cell-mediated immunity.
B)acantholysis.
C)Nikolsky sign.
D)anaphylaxis.

Answer 3

acantholysis.

Question 4

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

Question 5

What is the most common precipitating factor in the development of aphthous ulcers?

A)Allergy
B)Trauma
C)Systemic disease
D)Citrus foods

Question 6

Which one of the following has not been associated with erythema multiforme?

A)Herpes simplex
B)Histoplasmosis
C)Tuberculosis
D)HLA-B27

Question 7

Certain recurrent ulcers appear on movable mucosa. They are discrete, round-to-oval ulcers that are 3 to 5 mm in diameter and exhibit a yellowish-white fibrin center surrounded by an erythematous halo. They are called:

A)major aphthous ulcers.
B)Sutton disease.
C)herpetiform aphthous ulcers.
D)minor aphthous ulcers.

Question 8

Which one of the following ulcers may require a biopsy to make the diagnosis?

A)Minor aphthous ulcers
B)Major aphthous ulcers
C)Herpetiform aphthous ulcers
D)Behçet syndrome

Question 9

An antigenic marker called HLA-B27 is present in most patients with:

A)lichen planus.
B)Reiter syndrome.
C)erythema multiforme.
D)Stevens-Johnson syndrome.

Question 10

A certain 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, you suspect:

A)erythema multiforme.
B)fixed drug reaction.
C)Behçet syndrome.
D)angioedema.

Question 11

Which one of the following is an example of type I hypersensitivity?

A)Immune complexes formed between microorganisms and antibody in the circulating blood
B)Asthma
C)Autoimmune hemolytic anemia
D)Serum sickness

Question 12

Antihistaminic drugs are the principal method of treatment for:

A)urticaria.
B)minor aphthous ulcers.
C)herpetiform aphthous ulcers.
D)contact mucositis.

Question 13

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.

Question 14

Which one of the following routes of drug administration can cause the most significant hypersensitivity reaction?

A)Topical
B)Patch
C)Parenteral
D)Oral

Question 15

Which of the following is a protein molecule that is produced by plasma cells and is also called an immunoglobulin?

A)An autoimmune disease
B)A natural killer cell
C)Rheumatoid factor
D)An antibody

Question 16

Which of the following 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

Question 17

An example of natural passive immunity would occur 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.

Question 18

A prodromal period begins:

A)one week before the onset of ulcers.
B)one to 2 days before the onset of ulcers.
C)the day the ulcers erupt.
D)seven to 10 days before ulcers erupt.

Question 19

Which one of the following is not a component of Reiter syndrome?

A)Arthritis
B)Geographic tongue-like lesions
C)Urethritis
D)Wickham striae

Question 20

Which one of the following is not a specific component of immunity?

A)A humoral response
B)A cell-mediated response
C)Memory
D)Pavementing

Question 21

The classic appearance of what condition shown below is a pattern of interconnecting slender lines referred to as Wickham striae?

A)Lichen planus
B)Linea alba
C)Erythema multiforme
D)Reiter syndrome

Question 22

The classic triad of symptoms seen in 25% of patients with Hand-Schüller-Christian disease includes all of the following except:

A)well-defined or punched-out radiolucent areas in the skull.
B)exophthalmos.
C)cyclic neutropenia.
D)diabetes insipidus.

Question 23

Diagnosis of systemic lupus erythematosus (SLE) is made on the basis of:

A)skin lesions.
B)multiorgan involvement and the presence of anti-nuclear antibodies in the serum.
C)arthritis and arthralgia.
D)shortness of breath.

Question 24

Which one of the following is not a characteristic feature of pemphigus vulgaris?

A)Epithelial acantholysis
B)Bullae
C)Tzanck cells
D)Occurrence most commonly in females

Question 25

The most common oral manifestation of Sjögren syndrome is:

A)xerostomia.
B)xerophthalmia.
C)epimyoepithelial islands.
D)aphthous ulcers.

Question 26

The diagnosis of Behçet syndrome requires which of the following?

A)Two of the three principal manifestations
B)The presence of all three manifestations
C)A biopsy
D)A history of pemphigus vulgaris

Question 27

The most common oral site for cicatricial pemphigoid is the:

A)floor of the mouth.
B)gingiva.
C)palate.
D)tongue.

Question 28

Pemphigus vulgaris differs histologically from cicatricial pemphigoid in that pemphigus vulgaris involves:

A)degeneration of the epithelium.
B)connective tissue fragmentation.
C)significant numbers of inflammatory cells.
D)scarring.

Question 29

The eye damage that occurs in Sjögren syndrome is called:

A)xerophthalmia.
B)keratoconjunctivitis sicca.
C)conjunctivitis.
D)burning eyes.

Question 30

This patient has Sjögren syndrome and severe xerostomia. Which clinical feature most appropriately describes the changes on the tongue in this patient?

A)Dryness
B)Candidiasis
C)Loss of filiform and fungiform papillae
D)Fissures

Question 31

The histologic appearance of lesions in SLE may resemble:

A)an ulcer.
B)lichen planus.
C)pemphigus vulgaris.
D)erythema multiforme.

Question 32

The diagnosis of cicatricial pemphigoid is made on the basis of:

A)the clinical appearance of the lesions.
B)Nikolsky sign.
C)biopsy and histologic examination.
D)response to corticosteroids.

Question 33

Which form of Langerhans cell disease resembles lymphoma, affects children younger than 3 years, and has a rapidly fatal course?

A)Letterer-Siwe disease
B)Hand-Schüller-Christian disease
C)Eosinophilic granuloma
D)Chronic localized form

Question 34

The acute disseminated form of Langerhans cell disease is called:

A)eosinophilic granuloma.
B)Hand-Schüller-Christian disease.
C)Letterer-Siwe disease.
D)Reiter syndrome.

Question 35

The onset of this condition is explosive. It is characterized by skin and mucosal lesions. The skin lesions are referred to as target, iris, or bull's eye lesions. The mucosal lesions affect the buccal mucosa, lips, and tongue and appear as superficial ulcerations. The lip lesions are ulcerated, encrusted, and bloody. On the basis of this description, you suspect:

A)lichen planus.
B)erythema multiforme.
C)contact dermatitis.
D)SLE.

Question 36

Primary Sjögren syndrome occurs when:

A)another autoimmune disease accompanies salivary and lacrimal gland involvement.
B)there is only salivary and lacrimal gland involvement without the presence of another autoimmune disease.
C)rheumatoid arthritis is present.
D)Raynaud phenomenon is present.

Question 37

Treatment for pemphigus vulgaris involves:

A)high doses of systemic corticosteroids.
B)antihistamines.
C)antibiotics.
D)antiviral drugs.

Question 38

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.

Question 39

In which one of the following is the Langerhans cell not the proliferating cell?

A)Lichen planus
B)Letterer-Siwe disease
C)Hand-Schüller-Christian disease
D)Eosinophilic granuloma

Question 40

The most characteristic skin lesion in SLE is described as:

A)a blister.
B)urticaria.
C)a butterfly rash.
D)a bulla.

Question 41

The major divisions of the immune response are the cell-mediated and humoral responses. Both of these responses originate from what type of cell?

A)Plasma cell
B)Stem cell
C)T-lymphocyte
D)B-lymphocyte

Question 42

Factors such as tuberculosis, histoplasmosis, and herpes simplex virus are sometimes associated with what type of pathology?

A)Arthritis
B)Geographic tongue
C)Urethritis
D)Erythema multiforme

Question 43

The three main types of lymphocytes active during an immune response include all of the following except one. Which one is the exception?

A)T-cell
B)Natural killer cell
C)B-cell
D)C-cell

Question 44

Anaphylaxis occurs as a result of what type of hypersensitivity?

A)Type I
B)Type II
C)Type III
D)Type IV

Question 45

Which of the following is a systemic disease associated with aphthous ulcers?

A)Stafne bone cyst
B)Necrotizing sialometaplasia
C)Behçet syndrome
D)Erythema multiforme

Question 46

Each of the following statements about lichen planus is true except one. Which one is false?

A)The tongue is most commonly affected.
B)It is an idiopathic condition.
C)It is a benign condition.
D)It is a chronic condition.

Question 47

A patient presents with a diffuse swelling of the upper lip caused by permeability of deeper blood vessels. The skin covering the swelling appears normal and not accompanied by itching. This is characteristic of what pathological condition?

A)Minor aphthous ulcer
B)Lichen planus
C)Angioedema
D)Sjögren syndrome

Question 48

Which of the following is not appropriately paired?

A)Reactive arthritis-Reiter syndrome
B)Aphthous ulcer-canker sore
C)Urticaria-hives
D)Lichen planus-Sjögren syndrome

Question 49

An example of an immunopathologic condition in which one's own body cells are no longer tolerated is:

A)contact mucositis.
B)angioedema.
C)autoimmune disease.
D)contact dermatitis.

Question 50

In the mildest form of this autoimmune disease, oral lesions appear as erythematous plaques or erosions. White striae radiating from the center of the lesion are also commonly present. These oral lesions are indicative of what autoimmune disease?

A)Mucous membrane pemphigoid
B)Pemphigus vulgaris
C)Lupus erythematosus
D)Behçet syndrome

Question 51

Along with phagocytosis, the macrophage acts to process antigen material and present it on its surface to the T-helper cell. This stimulates both types of lymphocytes to travel from the lymphoid tissue or surrounding blood vessels to the injury site.

A)Both statements are true.
B)Both statements are false.
C)The first statement is true; the second is false.
D)The first statement is false; the second is true.

Question 52

This patient presents with an intraepithelial bulla from breakdown of the cellular adhesion between epithelial cells. The bulla ruptured, resulting in a painful ulcer with itching. The correct diagnosis for this progressive autoimmune disease is:

A)pemphigus vulgaris.
B)Reiter syndrome.
C)aphthous ulcers.
D)Langerhans cell disease.

Question 53

Each of the following is an example of an oral immunologic disorder except one. Which one is the exception?

A)Aphthous ulcers
B)Erythema multiforme
C)Fixed drug eruptions
D)Osteomyelitis

Question 54

The diagnosis of the type of aphthous ulcers is made on the basis of their distinctive clinical appearance, the location of the lesion, and a:

A)patient history.
B)therapeutic result.
C)radiographic examination.
D)laboratory test.

Question 55

The immune response differs from the inflammatory response because it has the capacity for memory and responds more quickly to a foreign substance if encountered again.

A)Both the statement and reason are correct and related.
B)Both the statement and reason are correct but not related.
C)The statement is correct but the reason is not.
D)Neither the statement nor the reason is correct.

Question 56

Which form of Langerhans cell disease occurs in children younger than 5 years, is multifocal, and a classic triad is seen in 25% of patients?

A)Letterer-Siwe disease
B)Hand-Schüller-Christian disease
C)Eosinophilic granuloma
D)Chronic localized form

Question 57

The various types of T-cell lymphocytes include the T-helper cell, the T-suppressor cell, the cytotoxic cell, and what other type of cell?

A)T-enhancement cell
B)Virulence cell
C)Memory cell
D)Oral cell

Question 58

When antibodies pass through the placenta to a developing fetus and protect the newborn infant from disease, this is referred to as _____ immunity.

A)natural active
B)acquired passive
C)acquired active
D)natural passive

Question 59

A cell product produced by the cells involved in the immune response is a(n):

A)attenuation.
B)cytokine.
C)dendritic cell.
D)Langerhans cell.

Question 60

Behçet syndrome is an acute, nonrecurring autoimmune disease consisting mainly of oral ulcers, genital ulcers, ocular inflammation, and skin lesions. Systemic and topical corticosteroids, as well as immunosuppressive drugs, are used in the management of Behçet syndrome.

A)Both statements are true.
B)Both statements are false.
C)The first statement is true; the second is false.
D)The first statement is false; the second is true.