Deck 3: Immunity and Immunologic Oral Lesions

Question 1

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.

Answer 1

Letterer-Siwe disease.

Question 2

The breakdown of cellular adhesion between epithelial cells is termed

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

Answer 2

acantholysis.

Question 3

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

Answer 3

An antibody

Question 4

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

Question 5

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 6

Antihistaminic drugs are the principal method of treatment for

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

Question 7

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

Question 8

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 9

Which is not a specific component of immunity?

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

Question 10

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

Question 11

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.

Question 12

Which ulcer may require a biopsy to make the diagnosis?

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

Question 13

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.

Question 14

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

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

Question 15

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.

Question 16

Which condition is not a component of Reiter syndrome?

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

Question 17

Which 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 18

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.

Question 19

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.

Question 20

Which route of drug administration causes the most significant hypersensitivity reaction?

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

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

Treatment for pemphigus vulgaris involves

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

Question 23

The eye damage that occurs in Sjögren syndrome is termed

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

Question 24

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

Question 25

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, which condition is suspected?

A) Lichen planus
B) Erythema multiforme
C) Contact dermatitis
D) SLE

Question 26

The histologic appearance of lesions in SLE may resemble

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

Question 27

The most characteristic skin lesion in SLE is described as

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

Question 28

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 29

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 30

The most common oral manifestation of Sjögren syndrome is

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

Question 31

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 32

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 33

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.

Question 34

The most common oral site for cicatricial pemphigoid is the

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

Question 35

In which condition is the Langerhans cell not the proliferating cell?

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

Question 36

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

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

Question 37

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 38

The diagnosis of Behçet syndrome requires which considerations?

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

Question 39

Which one is not a characteristic feature of pemphigus vulgaris?

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

Question 40

Primary Sjögren syndrome occurs when

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

Question 41

Antibodies pass through the placenta to a developing fetus and protect the newborn infant from disease; this is termed ____________ immunity.

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

Question 42

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

A) T-cell
B) NK cell
C) B-cell
D) C-cell

Question 43

Which conditions are not appropriately paired?

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

Question 44

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 pathologic condition?

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

Question 45

Decreased salivary flow that results in xerostomia is also known as

A) hyposalivation.
B) mucositis.
C) pruritus.
D) anaphylaxis.

Question 46

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 47

Anaphylaxis occurs as a result of what type of hypersensitivity?

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

Question 48

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 49

Which is a systemic disease associated with aphthous ulcers?

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

Question 50

NK cells have the ability to destroy foreign cells. NK cells are active against a variety of cells except one. Which is the exception?

A) Cancer cells
B) HIV and AIDS
C) Viruses
D) NK cells are active against A, B, and C

Question 51

Each condition 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 52

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.

Question 53

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 54

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 55

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 56

Each statement about lichen planus is true except one. Which statement 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 57

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 58

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 59

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 60

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

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

Question 61

A person with SLE may have oral manifestations similar to which other condition?

A) Lichen planus
B) Angioedema
C) Minor aphthous ulcers
D) Mucous membrane pemphigoid

Question 62

Some patients with Sjögren syndrome will also demonstrate the Raynaud phenomenon, which is a disorder that affects the

A) joints.
B) fingers and toes.
C) lacrimal glands.
D) eyelids.

Question 63

In addition to a clinical diagnosis, which additional category is used in diagnosing aphthous ulcers?

A) Laboratory
B) Differential
C) Historical
D) Therapeutic

Question 64

What is the group of medications used to treat patients with urticaria and angioedema?

A) Barbiturates
B) Antihistamines
C) Antidepressants
D) Corticosteroids

Question 65

Skin lesions, called target or bull's eye lesions, are characteristic of persons with erythema multiforme. If the oral cavity is also involved, which conditions are typically seen?

A) Gingival inflammation
B) Periodontal disease
C) Oral ulcers on the tongue and lips
D) Xerostomia

Question 66

Acantholysis, or the dissolution of the intercellular bridges of the prickle cell layer of the epithelium, is an oral manifestation of which disease?

A) HIV
B) Urticaria
C) Pemphigus vulgaris
D) Behçet syndrome

Question 67

Patients with Sjögren syndrome who experience xerostomia are at a high risk of the following conditions except one. Which is the exception?

A) Melanotic macules
B) Dental caries
C) Oral candidiasis
D) Periodontal disease

Question 68

What is a clinical difference between lichen planus and linea alba?

A) Lichen planus may be removed with a gauze square; linea alba cannot be removed.
B) Lichen planus appears more bluish; linea alba appears white.
C) Lichen planus may appear on the buccal mucosa as well as the tongue, lips, and floor of the mouth; linea alba is confined to the buccal mucosa.
D) Lichen planus is asymptomatic; linea alba may cause erosions, bullae, or ulcers.

Question 69

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

A) Tobacco use
B) Trauma
C) Emotional stress
D) Infection

Question 70

Which statement is false about the T-cell lymphocyte?

A) The T-cell lymphocyte develops from a bone marrow stem cell.
B) The T-cell lymphocyte travels to the liver and is processed into a mature cell.
C) The T-cell lymphocyte has a special receptor on its surface.
D) The T-cell lymphocyte increases the functioning of the B-cell.

Question 71

Persons with Behçet syndrome suffer from the following symptoms except one. Which is the exception?

A) Nikolsky sign
B) Oral ulcers
C) Ocular inflammation
D) Genital lesions

Question 72

What is the common name for urticaria?

A) Hives
B) Dermatitis
C) Dry socket
D) Jaundice

Question 73

Oral lesions accompanying skin lesions may occur in the following diseases except one. Which is the exception?

A) SLE
B) Pemphigus vulgaris
C) Lichen planus
D) Aphthous ulcers