Question 1

Which is a condition that involves a deficiency in number, function, or interrelationships of the involved white blood cells and their products?

Accepted Answer

Immunodeficiency is a type of immunopathologic condition that involves a deficiency in number, function, or interrelationships of the involved white blood cells and their products. Autoimmune disease is characterized by tissue injury caused by a humoral or cell-mediated immune response against constituents of the body's own tissues. Leukocytosis is an increase in the circulating white blood cells. It is a systemic sign of an inflammatory response. Anaphylaxis is a severe type of hypersensitivity reaction.

Question 2

An example of natural passive immunity occurs when

Accepted Answer

Natural passive immunity occurs when antibodies from a mother pass through the placenta to the developing fetus. Active immunity occurs naturally when a microorganism causes a disease. Active acquired immunity occurs as a result of vaccination. After vaccination, the immune system produces a stronger response and prevents the development of the disease. This production of acquired immunity is called immunization.

Question 3

Which ulcer may require a biopsy to make the diagnosis?

Accepted Answer

Major aphthous ulcers sometimes require a biopsy to rule out other causes of ulceration such as squamous cell carcinoma or deep fungal infections. Minor aphthous ulcers are diagnosed through clinical appearance, location, and complete patient history. Herpetiform aphthous ulcers resemble those associated with the herpes simplex virus, but there are no systemic signs or symptoms as in primary herpes simplex infection. Behçet syndrome is a multisystem disorder characterized by numerous clinical manifestations. Although there are oral ulcerations, the diagnosis requires the presence of other features such as genital, ocular, and skin lesions.

Question 4

The diagnosis of lichen planus is made on the basis of

Accepted Answer

Diagnosis of lichen planus is made on the basis of clinical appearance and histologic findings of biopsy tissue. Radiographic findings do not contribute to the diagnosis of lichen planus. History of the condition is not definitive enough for the diagnosis of lichen planus. Topical and systemic corticosteroids have been used in the treatment of lichen planus but not to establish the diagnosis.

Question 5

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

Accepted Answer

When the reaction occurs after parenteral administration (injection), it may be more severe because the allergen can be carried quickly to many parts of the body through the bloodstream. It takes more time for topically applied drugs to enter the bloodstream compared with parenterally applied (injected) drugs. It takes more time for a drug to enter the bloodstream via a patch compared with parenteral administration. It takes more time for oral medications to enter the bloodstream than parenterally applied drugs.

Question 6

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

Accepted Answer

An antigenic marker called HLA-B27 is present in most patients with Reiter syndrome. Lichen planus is diagnosed through the clinical and histologic appearance of biopsy tissue. Erythema multiforme is thought to be a hypersensitivity reaction involving the skin and mucous membranes. Stevens-Johnson syndrome is the most severe form of erythema multiforme.

Question 7

The breakdown of cellular adhesion between epithelial cells is termed

Accepted Answer

Acantholysis is the dissolution of the intracellular bridges of the prickle cell layer of epithelium. Cell-mediated immunity is immunity in which the predominant role is played by T-lymphocytes. Nikolsky sign occurs when the superficial epithelium separates easily from the basal layer on exertion of firm, sliding, manual pressure. Anaphylaxis is a severe type of systemic hypersensitivity reaction.

Question 8

The acute disseminated form of Langerhans cell disease is termed

Accepted Answer

Letterer-Siwe disease is the acute disseminated form of Langerhans cell disease. Eosinophilic granuloma is a solitary or chronic localized form of Langerhans cell disease. Hand-Schüller-Christian disease is the chronic disseminated or multifocal form of Langerhans cell disease. Reiter syndrome is not a form of Langerhans cell disease.

Question 9

Wickham striae is a term used to describe the oral mucosal lesions of

Accepted Answer

Wickham striae describe the slender white lines seen in lichen planus. Linea alba is the white line on the buccal mucosa that extends anteroposteriorly along the occlusal plane. Frictional keratosis occurs when there is chronic cheek and tongue chewing and chewing on edentulous ridges. Erythema multiforme is an acute self-limited disease that affects the skin and mucous membranes. The skin lesions are described as iris, target, or bull's eye lesions. The mucosal lesions are superficial ulcerations.

Question 10

Which protein molecule is produced by plasma cells and is also termed an immunoglobulin?

Accepted Answer

An antibody is a protein molecule, also called an immunoglobulin, that is produced by plasma cells and reacts with a specific antigen. An autoimmune disease is a disease characterized by tissue injury caused by a humoral or cell-mediated response against constituents of the body's own tissues. An NK cell is a lymphocyte that is part of the body's innate immunity. Rheumatoid factor is a protein, immunoglobulin M (IgM), found in serum and detected in laboratory tests. It is associated with rheumatoid arthritis and other autoimmune diseases.

Question 11

Which is not a specific component of immunity?

Accepted Answer

Pavementing is the adherence of white blood cells to the walls of a blood vessel during an inflammatory response. Humoral immunity involves the production of antibodies. The B-lymphocyte is the predominant cell. Cell-mediated immunity involves the T-lymphocyte. Memory is an important function of the immune system. Certain lymphocytes retain the memory of an antigen after an initial encounter, allowing for faster immune responses.

Question 12

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

Accepted Answer

Trauma is the most common precipitating factor in the development of aphthous ulcers. Allergies do not cause aphthous ulcers. Aphthous ulcers do occur in association with certain systemic diseases, but they are not the most common precipitating factor. Citrus foods can trigger episodes of aphthous ulcers, but they are not the most common precipitating factor.

Question 13

A prodromal period begins

Accepted Answer

The prodromal period occurs 1 to 2 days before ulcers appear. There are a burning sensation and soreness where the ulcers will appear. The prodromal period before ulceration is only 1 to 2 days. Prodromal symptoms should not occur 1 week before ulceration. The prodromal period does not occur on the day of ulceration. The prodromal period precedes ulceration by only 1 to 2 days. Prodromal symptoms should not occur 7 to 10 days before ulceration.

Question 14

Which lymphocyte matures without passing through the thymus and later can develop into a plasma cell that produces antibodies?

Accepted Answer

The B-lymphocyte matures without passing through the thymus and later can develop into a plasma cell that produces antibodies. The T-lymphocyte matures in the thymus before migrating to tissues. A macrophage is a large tissue-bound mononuclear phagocyte derived from monocytes circulating in the blood. The LE cell is an atypical mature neutrophil characteristic of lupus erythematosus and other autoimmune diseases.

Question 15

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

Accepted Answer

Minor aphthous ulcers are recurrent and appear on movable mucosa. They are 3 to 5 mm in diameter and have a yellowish-white fibrin center surrounded by an erythematous halo. Major aphthous ulcers are deeper in the tissue, are larger (5 to 10 mm), take much longer to heal, and often heal with scarring. Sutton disease is the same as major aphthous ulcers. Herpetiform aphthous ulcers are very tiny (1 to 2 mm). The size of this type of aphthous ulcer is similar to the size of ulcers caused by the herpes simplex virus.

Question 16

Which is an example of type I hypersensitivity?

Accepted Answer

Asthma is an example of type I hypersensitivity. In type III hypersensitivity, immune complexes are formed between microorganisms and antibody in the circulating blood. Autoimmune hemolytic anemia is a type II hypersensitivity reaction. Serum sickness is a classic example of a type III hypersensitivity reaction.

Question 17

Which condition is not a component of Reiter syndrome?

Accepted Answer

Wickham striae are associated with lichen planus. Arthritis is a component of Reiter syndrome. Oral mucosal lesions that resemble geographic tongue have been described in patients with Reiter syndrome. Urethritis is associated with Reiter syndrome.

Question 18

In which type of immune response do B-lymphocytes and antibodies play the predominant role?

Accepted Answer

In humoral immunity the B-lymphocytes and antibodies play the predominant role. In cell-mediated immunity, the T-lymphocyte plays the predominant role. The immune complex is a combination of antigen and antibody. Passive immunity occurs when antibodies produced by another person are used to protect an individual from an infectious disease.

Question 19

Antihistaminic drugs are the principal method of treatment for

Accepted Answer

Urticaria, also called hives, appears as well-demarcated areas of swelling on the skin accompanied by pruritus. The release of the chemical mediator histamine causes the increased vascular permeability. Antihistaminic drugs are used to treat urticaria. Minor aphthous ulcers heal spontaneously in 7 to 10 days. They may be treated with topical corticosteroid or nonsteroidal antiinflammatory medications. Herpetiform aphthous ulcers do not respond to antihistaminic drugs. They may respond to corticosteroid therapy or topical liquid tetracycline. Contact mucositis results from direct contact of an allergen with the mucosa. Treatment begins with removal of the cause.

Question 20

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?

Accepted Answer

Erythema multiforme is a hypersensitivity reaction that affects the skin and mucous membranes. Bloody crusted lips are a common presentation. The onset is explosive, and the skin lesions are referred to as target, iris, or bull's eye lesions. Fixed drug eruptions are lesions that appear in the same site each time a drug is introduced. There may be a single red patch or macule on the skin. Mucous membranes are rarely involved. Behçet syndrome is a chronic recurrent autoimmune disease consisting primarily of oral ulcers, genital ulcers, and ocular inflammation. Angioedema appears as a diffuse swelling of tissue caused by permeability of deeper blood vessels.

Quiz 3: Immunity and Immunologic Oral Lesions