31 minute read
Chapter 03: Immunity and Immunologic Oral Lesions
Ibsen: Oral Pathology for the Dental Hygienist, 7th Edition
Multiple Choice
1. The breakdown of cellular adhesion between epithelial cells is termed a. cell-mediated immunity. b. acantholysis. c. Nikolsky sign. d. anaphylaxis.
ANS: B
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.
REF: Pemphigus, page 101 OBJ: 1 a. An autoimmune disease b. A natural killer (NK) cell c. Rheumatoid factor d. An antibody
2. Which protein molecule is produced by plasma cells and is also termed an immunoglobulin?
ANS: D
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.
REF: Vocabulary, page 79 | B-cell Lymphocyte, page 81 OBJ: 1 a. T-lymphocyte b. B-lymphocyte c. Macrophage d. LE cell
3. Which lymphocyte matures without passing through the thymus and later can develop into a plasma cell that produces antibodies?
ANS: B
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.
REF: Vocabulary, page 79 | B-cell Lymphocyte, page 81 OBJ: 3 a. Cell-mediated immunity b. Immune complex c. Humoral immunity d. Passive immunity
4. In which type of immune response do B-lymphocytes and antibodies play the predominant role?
ANS: C
In humoral immunity the B-lymphocytes and antibodies play the predominant role. In cellmediated 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.
REF: Major Divisions of the Immune Response, page 84 OBJ: 2 a. A humoral response b. A cell-mediated response c. Memory d. Pavementing
5. Which is not a specific component of immunity?
ANS: D
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 Blymphocyte 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.
REF: Major Divisions of the Immune Response; Memory and Immunity, pages 80, 84
OBJ: 6
6. 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.
ANS: A
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.
REF: Types of Immunity, page 85 OBJ: 7 a. Immune complexes formed between microorganisms and antibody in the circulating blood b. Asthma c. Autoimmune hemolytic anemia d. Serum sickness
7. Which is an example of type I hypersensitivity?
ANS: B
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.
REF: Type I Hypersensitivity, page 85 OBJ: 8 a. Topical b. Patch c. Parenteral d. Oral
8. Which route of drug administration causes the most significant hypersensitivity reaction?
ANS: C
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.
REF: Hypersensitivity to Drugs, page 86 OBJ: 8 a. Autoimmune disease b. Leukocytosis c. Immunodeficiency d. Anaphylaxis
9. Which is a condition that involves a deficiency in number, function, or interrelationships of the involved white blood cells and their products?
ANS: C
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.
REF: Immunodeficiency, page 87 OBJ: 8 a. Allergy b. Trauma c. Systemic disease d. Citrus foods
10. What is the most common precipitating factor in the development of aphthous ulcers?
ANS: B
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.
REF: Aphthous Ulcers, Recurrent Aphthous Ulcers, page 87
OBJ: 11
11. 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.
ANS: D
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.
REF: Types of Aphthous Ulcers, page 87 a. Minor aphthous b. Major aphthous c. Herpetiform aphthous d. Behçet syndrome
12. Which ulcer may require a biopsy to make the diagnosis?
ANS: B
OBJ: 11
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.
REF: Types of Aphthous Ulcers, page 87
OBJ: 11
13. Antihistaminic drugs are the principal method of treatment for a. urticaria. b. minor aphthous ulcers. c. herpetiform aphthous ulcers. d. contact mucositis.
ANS: A
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.
REF: Urticaria and Angioedema, Treatment and Prognosis, page 90
OBJ: 13
14. 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.
ANS: B
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.
REF: Types of Aphthous Ulcers, page 87
OBJ: 11 a. Erythema multiforme b. Fixed drug reaction c. Behçet syndrome d. Angioedema
15. 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?
ANS: A
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.
REF: Erythema Multiforme, page 91 OBJ: 14 b. frictional keratosis. c. lichen planus. d. erythema multiforme.
16. Wickham striae is a term used to describe the oral mucosal lesions of a. linea alba.
ANS: C
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.
REF: Lichen Planus, page 93 OBJ: 15
17. 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.
ANS: B
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.
REF: Types of Lichen Planus, Diagnosis, page 94 OBJ: 15 a. Arthritis b. Geographic tongue–like lesions c. Urethritis d. Wickham striae
18. Which condition is not a component of Reiter syndrome?
ANS: D
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.
REF: Reactive Arthritis (Reiter Syndrome), page 95 OBJ: 16
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.
ANS: B
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.
REF: Reactive Arthritis (Reiter Syndrome), page 95 OBJ: 16
20. 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.
ANS: C
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.
REF: Langerhans Cell Histiocytosis (Langerhans Cell Disease), page 96
OBJ: 17 a. Letterer–Siwe disease b. Hand–Schüller–Christian disease c. Eosinophilic granuloma d. Chronic localized form
21. Which form of Langerhans cell disease resembles lymphoma, affects children younger than age 3, and has a rapidly fatal course?
ANS: A
Letterer–Siwe resembles lymphoma, affects children under 3 years, and has a rapidly fatal course. It is the most severe form of Langerhans cell disease. Hand–Schüller–Christian disease is the multifocal form of Langerhans cell disease. It occurs in children younger than 5 years. A classic triad is seen in 25% of patients. Eosinophilic granuloma affects older children and young adults. The chronic localized form is the same as eosinophilic granuloma.
REF: Langerhans Cell Histiocytosis (Langerhans Cell Disease), page 96
OBJ: 17
22. 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.
ANS: C
Cyclic neutropenia is an inherited disorder characterized by a cyclic decrease in the number of circulating neutrophils. Aphthous ulcers, gingival recession, and alveolar bone loss can be seen in association with this systemic condition. Well-defined or punched-out radiolucent areas in the skull are part of the triad of symptoms in chronic disseminated Hand–Schüller–Christian disease. Exophthalmos is a part of the triad of symptoms in chronic disseminated Hand–Schüller–Christian disease. Diabetes insipidus is part of the triad of symptoms in chronic disseminated Hand–Schüller–Christian disease.
REF: Langerhans Cell Histiocytosis (Langerhans Cell Disease), page 96 OBJ: 12
23. 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.
ANS: A
Sjögren syndrome is an autoimmune disease that affects the salivary and lacrimal glands. Sjögren syndrome is not an allergic reaction. Sjögren syndrome is not a form of aphthous ulcers. Sjögren syndrome is not a type of Langerhans cell disease.
REF: Sjögren Syndrome, page 97 OBJ: 18
24. The most common oral manifestation of Sjögren syndrome is a. xerostomia. b. xerophthalmia. c. epimyoepithelial islands. d. aphthous ulcers.
ANS: A
Xerostomia, or dry mouth, is the most common oral manifestation of Sjögren syndrome. Xerophthalmia is dry eyes caused by lack of lacrimal flow. Epimyoepithelial islands are seen histologically in Sjögren syndrome, but are not the most common oral manifestation. Aphthous ulcers are not associated with Sjögren syndrome, but are seen more commonly in Behçet syndrome, another autoimmune disease.
REF: Sjögren Syndrome, page 97 OBJ: 18
25. 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.
ANS: B
Primary Sjögren syndrome occurs when there is only salivary and lacrimal gland involvement without the presence of another autoimmune disease. Secondary Sjögren syndrome occurs when another autoimmune condition accompanies the salivary and lacrimal gland involvement. Rheumatoid arthritis is an autoimmune disease that can be a component of secondary Sjögren syndrome. Twenty percent of patients with Sjögren syndrome have Raynaud phenomenon. It is characterized by pallor of the skin that results from vasoconstriction and reduced blood flow. The toes and fingers are affected.
REF: Sjögren Syndrome, page 97 OBJ: 18
26. The eye damage that occurs in Sjögren syndrome is termed a. xerophthalmia. b. keratoconjunctivitis sicca. c. conjunctivitis. d. burning eyes.
ANS: B
Keratoconjunctivitis sicca is damage to the eye in Sjögren syndrome. It is confirmed by eye examination. Xerophthalmia, or dry eyes, may be present in Sjögren syndrome. Conjunctivitis is inflammation of the conjunctiva. Burning eyes may also be a component of Sjögren syndrome.
REF: Sjögren Syndrome, page 97 OBJ: 18
27. 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.
ANS: B
Diagnosis of systemic SLE is made on the basis of multiorgan involvement and the presence of antinuclear antibodies in the serum. Skin lesions occur in 85% of individuals, but the diagnosis is not made on the basis of skin lesions. Arthritis and arthralgia may be components of SLE, but are not sufficient to make the diagnosis. Shortness of breath may be a component of SLE, but is not significant to the diagnosis.
REF: Systemic Lupus Erythematosus, Diagnosis, page 99 OBJ: 18
28. The most characteristic skin lesion in SLE is described as a. a blister. b. urticaria. c. a butterfly rash. d. a bulla.
ANS: C
The classic skin lesion in SLE is described as a butterfly rash. A blister is not the classic skin lesion in SLE. Urticaria is associated with a hypersensitivity reaction. A bulla may occur in SLE, but it is not the most characteristic skin lesion.
REF: Systemic Lupus Erythematosus, Diagnosis, page 99 OBJ: 18
29. The histologic appearance of lesions in SLE may resemble a. an ulcer. b. lichen planus. c. pemphigus vulgaris. d. erythema multiforme.
ANS: B
The histologic appearance of lesions in SLE may resemble lichen planus. An ulcer appears as a break in the epithelium and is histologically nonspecific for SLE or lichen planus. Pemphigus vulgaris is a severe progressive autoimmune disease characterized by intraepithelial blister formation that results from breakdown of the cellular adhesion between epithelial cells. In erythema multiforme, the microscopic appearance is nonspecific.
REF: Systemic Lupus Erythematosus, Diagnosis, page 99 OBJ: 18 a. Epithelial acantholysis b. Bullae c. Tzanck cells d. Occurrence most commonly in females
30. Which one is not a characteristic feature of pemphigus vulgaris?
ANS: D
No sex predilection exists in pemphigus vulgaris. Epithelial acantholysis occurs in pemphigus vulgaris. Bullae do appear in pemphigus vulgaris. Tzanck cells, or acantholytic cells, appear in pemphigus vulgaris as rounded epithelial cells and are present in the area of separation of epithelial cells.
REF: Pemphigus Vulgaris, pages 101-102 OBJ: 18
31. Treatment for pemphigus vulgaris involves a. high doses of systemic corticosteroids. b. antihistamines. c. antibiotics. d. antiviral drugs.
ANS: A
High doses of systemic corticosteroids are used in the treatment of pemphigus vulgaris. Antihistamines are not used to treat pemphigus vulgaris. Antibiotics are not used to treat pemphigus vulgaris. Antiviral drugs are not used to treat pemphigus vulgaris.
REF: Pemphigus Vulgaris, Treatment and Prognosis, page 102 OBJ: 18
32. The most common oral site for cicatricial pemphigoid is the a. floor of the mouth. b. gingiva. c. palate. d. tongue.
ANS: B
The gingiva is the most common site for cicatricial pemphigoid. The floor of the mouth is not a common site for cicatricial pemphigoid. The palate is not a common site for cicatricial pemphigoid. The tongue is not a common site for cicatricial pemphigoid.
REF: Mucous Membrane Pemphigoid, page 102 OBJ: 18
33. 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.
ANS: C
Biopsy and histologic examination are used to diagnose cicatricial pemphigoid. The clinical appearance of lesions is not sufficient for the diagnosis of cicatricial pemphigoid. The Nikolsky sign is not sufficient to determine the diagnosis of cicatricial pemphigoid. Although corticosteroids are the recommended treatment for cicatricial pemphigoid, diagnosis of the condition is not made through therapeutic diagnosis.
REF: Mucous Membrane Pemphigoid, Diagnosis, page 102 OBJ: 18
34. 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.
ANS: A
The lesions of pemphigus vulgaris histologically exhibit acantholysis, which is degeneration of the epithelium. In pemphigus vulgaris, the basal cells of the epithelium and the basement membrane remain attached to the underlying connective tissue. Inflammatory cells are present in both cicatricial pemphigoid and pemphigus vulgaris. Scarring occurs in lesions associated with cicatricial pemphigoid.
REF: Pemphigus Vulgaris, page 101 OBJ: 18 a. Two of the three principal manifestations b. The presence of all three manifestations c. A biopsy d. A history of pemphigus vulgaris
35. The diagnosis of Behçet syndrome requires which considerations?
ANS: A
Behçet syndrome is a chronic recurrent autoimmune disease consisting primarily of oral ulcers, genital ulcers, and ocular inflammation. Two of these three principal manifestations must be present for the diagnosis. Only two principal manifestations must be present for the diagnosis of Behçet syndrome. A biopsy is not necessary for the diagnosis of Behçet syndrome. Pemphigus vulgaris is another severe progressive autoimmune disease. Pemphigus vulgaris is not associated with Behçet syndrome.
REF: Behçet Syndrome, Diagnosis, page 103 OBJ: 18 a. Lichen planus b. Linea alba c. Erythema multiforme d. Reiter syndrome
36. The classic appearance of what condition shown below is a pattern of interconnecting slender lines referred to as Wickham striae?
ANS: A
The classic clinical appearance of lichen planus is a pattern of slender white interconnecting lines referred to as Wickham striae. Linea alba is the white line that develops on the buccal mucosa along the occlusal plane; it is more prominent in patients with clenching or bruxism habits. Erythema multiforme is an acute self-limiting disease affecting the skin and mucous membranes; it is thought to be a hypersensitivity reaction. The oral lesions in Reiter syndrome are characterized by aphthous-like ulcerations, erythematous lesions, and geographic tongue–like lesions.
REF: Lichen Planus, page 93 OBJ: 15 a. Lichen planus b. Letterer–Siwe disease c. Hand–Schüller–Christian disease d. Eosinophilic granuloma
37. In which condition is the Langerhans cell not the proliferating cell?
ANS: A
In lichen planus, there is degeneration of the basal cell layer, sawtooth rete ridges, and a broad band of lymphocytes in the connective tissue immediately subjacent to the epithelium. Letterer–Siwe disease is an acute disseminated form of Langerhans cell disease. Hand–Schüller–Christian disease is a chronic disseminated or multifocal form of Langerhans cell disease. Eosinophilic granuloma is the solitary or chronic localized form of Langerhans cell disease.
REF: Langerhans Cell Histiocytosis (Langerhans Cell Disease), page 96
OBJ: 15 a. Lichen planus b. Erythema multiforme c. Contact dermatitis d. SLE
38. 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?
ANS: B
The skin lesions of erythema multiform are described as target, iris, or bull’s eye lesions. The mucosal lesions are superficial ulcerations. The lip lesions are bloody and encrusted. In lichen planus, skin lesions are 2- to 4-mm papules. In contact dermatitis, skin lesions result from direct contact with the allergen. The lesions may be erythematous with swelling and vesicles. In SLE, the most classic skin lesion appears on the face and is described as a butterfly rash. The erythematous rash involves the cheeks and the bridge of the nose.
REF: Erythema Multiforme, page 91 OBJ: 15 a. Dryness b. Candidiasis c. Loss of filiform and fungiform papillae d. Fissures
39. This patient has Sjögren syndrome and severe xerostomia. Which clinical feature most appropriately describes the changes on the tongue in this patient?
ANS: C
Loss of filiform and fungiform papillae is the main clinical feature that is responsible for the appearance of this patient’s tongue. The entire mouth is dry, but this is not the main clinical feature involving changes in the tongue. Candidiasis may be present, but it does not describe the changes seen in this patient’s tongue. Fissures can occur as a result of the dryness, but they are not the main clinical feature involving the tongue.
REF: Sjögren Syndrome, page 97 OBJ: 18
40. 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.
ANS: B
A cytokine is a cell product produced by cells involved in the immune response. Attenuation describes the reduction in the severity of a disease or the virulence of a pathogenic agent, as is done in the development of certain vaccines. A dendritic cell is a white blood cell that acts as an antigen-processing cell in the skin and mucosa. A Langerhans cell is a specialized dendritic cell, found in skin and mucosa, that is involved in the immune response.
REF: Cellular Involvement in the Immune Response, page 81 OBJ: 1 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.
41. 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.
ANS: A
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. Both the statement and reason are correct and related.
REF: Acquired Immune Response, pages 80-81 OBJ: 2 a. T-cell b. NK cell c. B-cell d. C-cell
42. The three main types of lymphocytes active during an immune response include the following except one. Which one is the exception?
ANS: D
The C-cell is not a type of lymphocyte active during an immune response. The T-cell is a type of lymphocyte active during an immune response. The NK cell is a type of lymphocyte active during an immune response. The B-cell is a type of lymphocyte active during an immune response
REF: Cellular Involvement in the Immune Response, page 81 OBJ: 3 a. T-enhancement cell b. Virulence cell c. Memory cell d. Oral cell
43. 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?
ANS: C
The memory cell is a type of T-cell lymphocyte. The T-enhancement cell is not a type of T-cell lymphocyte. The virulence cell is a not a type of T-cell lymphocyte. The oral cell is not a type of T-cell lymphocyte.
REF: T-cell Lymphocyte, page 83 OBJ: 4 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.
44. 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.
ANS: A
Both statements are true.
REF: Macrophage, page 83 OBJ: 5 a. Plasma cell b. Stem cell c. T-lymphocyte d. B-lymphocyte
45. The major divisions of the immune response are the cell-mediated and humoral responses. Both of these responses originate from what type of cell?
ANS: B
Both the cell-mediated response and the humoral response originate from the stem cell. The plasma cell is part of the humoral response, but not the cell-mediated response. The Tlymphocyte is part of the cell-mediated response, but not the humoral response. The Blymphocyte is part of the humoral response, but not the cell-mediated response.
REF: Major Divisions of the Immune Response, Fig. 3.6, page 84
OBJ: 6 a. natural active b. acquired passive c. acquired active d. natural passive
46. Antibodies pass through the placenta to a developing fetus and protect the newborn infant from disease; this is termed ____________ immunity.
ANS: D
Natural passive immunity is acquired when antibodies pass through the placenta to a developing fetus and protect the newborn infant from disease. Natural active immunity is acquired when a pathogenic microorganism causes the disease. Acquired passive immunity occurs through an injection of antibodies. Acquired active immunity occurs through immunization.
REF: Types of Immunity, page 85 OBJ: 7 a. I b. II c. III d. IV
47. Anaphylaxis occurs as a result of what type of hypersensitivity?
ANS: A
Type I, or anaphylactic type, hypersensitivity is a reaction that occurs immediately, within minutes of exposure to a previously encountered antigen or allergen. Type II, or cytotoxic type, hypersensitivity occurs when an antibody combines with an antigen that is bound to the surface of tissue cells. Type III, or immune complex type, hypersensitivity is marked by the formation of immune complexes between microorganisms and antibody in the circulating blood. Type IV, or cell-mediated type, hypersensitivity involves a cell-mediated immune response rather than a humoral response that produces antibodies.
REF: Type I Hypersensitivity, page 86 OBJ: 8
48. 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.
ANS: C
Autoimmune disease occurs when one’s own body cells are no longer tolerated. Contact mucositis results from direct contact of an allergen with the oral mucosa or skin. Angioedema is a skin and oral mucosal hypersensitivity. Contact dermatitis occurs as a result of direct contact of an allergen with the oral mucosa or skin.
REF: Autoimmune Diseases, page 86 OBJ: 9 a. Aphthous ulcers b. Erythema multiforme c. Fixed drug eruptions d. Osteomyelitis
49. Each condition is an example of an oral immunologic disorder except one. Which one is the exception?
ANS: D
Osteomyelitis is an example of an infectious disease. Aphthous ulcers are an example of an oral immunologic disorder. Erythema multiforme is an example of an oral immunologic disorder. Fixed drug eruptions are an example of an oral immunologic disorder.
REF: Aphthous Ulcers, page 87 | Erythema Multiforme, page 91 | Drug Eruption, page 91
OBJ: 10
50. 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.
ANS: A
A complete patient history is part of the final diagnosis of aphthous ulcers. Therapeutic results do not aid in the diagnosis of aphthous ulcers. Radiographic examinations are not diagnostic for aphthous ulcers. Laboratory results are not specific for any form of aphthous ulcer.
REF: Types of Ulcers, Diagnosis, pages 87, 89 OBJ: 10 a. Stafne bone cyst b. Necrotizing sialometaplasia c. Behçet syndrome d. Erythema multiforme
51. Which is a systemic disease associated with aphthous ulcers?
ANS: C
Behçet syndrome is a disease characterized by aphthous ulcers, genital ulcers, ocular inflammation, and arthritis. Stafne bone cyst is a developmental disorder and is not considered a systemic disease. Necrotizing sialometaplasia is an inflammatory condition of the salivary glands. Erythema multiforme is not a systemic disease.
REF: Behçet Syndrome, page 103 OBJ: 12 a. Minor aphthous ulcer b. Lichen planus c. Angioedema d. Sjögren syndrome
52. 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?
ANS: C
This description is indicative of angioedema. Minor aphthous ulcers are round-to-oval ulcers that exhibit a yellowish-white fibrin surface surrounded by a halo of erythema. Lichen planus appears as interconnecting white lines and circles on the oral mucosa or skin. Sjögren syndrome is characterized by a decrease in salivary gland secretion.
REF: Urticaria and Angioedema, page 89 OBJ: 13 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.
53. Each statement about lichen planus is true except one. Which statement is false?
ANS: A
Lichen planus occurs on the skin and oral mucosa; in the latter case, the buccal mucosa is most frequently affected. Many factors have been implicated in lichen planus; however, the cause remains unknown. Lichen planus is considered benign. Lichen planus is a chronic disease.
REF: Lichen Planus, pages 92-93 OBJ: 15 a. Reactive arthritis—Reiter syndrome b. Aphthous ulcer—canker sore c. Urticaria—hives d. Lichen planus—Sjögren syndrome
54. Which conditions are not appropriately paired?
ANS: D
No association exists between lichen planus and Sjögren syndrome. Reactive arthritis is another name for Reiter syndrome. An aphthous ulcer is also called a canker sore. Urticaria is also referred to as hives.
REF: Lichen Planus, pages 92-93 | Sjögren Syndrome, page 97 OBJ: 16 a. Letterer–Siwe disease b. Hand–Schüller–Christian disease c. Eosinophilic granuloma d. Chronic localized form
55. 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?
ANS: B
Hand–Schüller–Christian disease is the multifocal form of Langerhans cell disease. It occurs in children younger than 5 years. A classic triad is seen in 25% of patients. Letterer–Siwe disease resembles lymphoma, affects children younger than 3 years, and has a rapidly fatal course. It is the most severe form of Langerhans cell disease. Eosinophilic granuloma affects older children and young adults. The chronic localized form is the same as eosinophilic granuloma.
REF: Langerhans Cell Histiocytosis, page 96 OBJ: 17 a. Mucous membrane pemphigoid b. Pemphigus vulgaris c. Lupus erythematosus d. Behçet syndrome
56. 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?
ANS: C
In the mildest form of lupus erythematosus, oral lesions appear as erythematous plaques or erosions. White striae radiating from the center of the lesion are also commonly present. Oral lesions in mucous membrane pemphigoid are clinically described as desquamative gingivitis. The oral lesions in pemphigus vulgaris range from shallow ulcers to fragile vesicles or bullae. The oral ulcers that occur in Behçet syndrome are very similar in appearance to aphthous ulcers.
REF: Systemic Lupus Erythematosus, page 99 OBJ: 18
57. 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.
ANS: A
Acantholysis (breakdown of the cellular adhesion between epithelial cells) is characteristic of pemphigus vulgaris. Reiter syndrome does not present with a bulla that ruptures, resulting in an ulcer. Aphthous ulcers are not a progressive autoimmune disease. Oral manifestations of Langerhans cell disease include loss of bone support, sore mouth, halitosis, gingivitis, and sore teeth.
REF: Pemphigus Vulgaris, page 101 OBJ: 18 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.
58. 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.
ANS: D
Behçet syndrome is chronic and recurring; and systemic and topical corticosteroids, as well as immunosuppressive drugs, are used to treat it. The first statement is false: Behçet syndrome is not acute and it does recur. The second statement is true: systemic and topical corticosteroids, as well as immunosuppressive drugs, are used to treat it. The first statement is false; the second is true.
REF: Behçet Syndrome, page 103 OBJ: 20
59. Decreased salivary flow that results in xerostomia is also known as a. hyposalivation. b. mucositis. c. pruritus. d. anaphylaxis.
ANS: A
Hyposalivation is the decreased salivary flow that may result in dry mouth, or xerostomia. Mucositis refers to mucosal inflammation because of a disease process. Pruritus is another term for itching. Anaphylaxis is a severe or immediate type of hypersensitivity in which an exaggerated immunologic reaction occurs.
REF: Vocabulary, page 79 OBJ: 1 a. Cancer cells b. HIV and AIDS c. Viruses d. NK cells are active against A, B, and C
60. NK cells have the ability to destroy foreign cells. NK cells are active against a variety of cells except one. Which is the exception?
ANS: B
NK cell function is abnormal in HIV-related acquired immunodeficiency syndrome. NK cells are active against cancer cells. NK cells are active against most viruses. NK cells are active against most viruses and cancer cells, but not HIV-related AIDS.
REF: Cellular Involvement in the Immune Response, page 83 OBJ: 3 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.
61. Which statement is false about the T-cell lymphocyte?
ANS: B
The T-cell lymphocyte does not travel to the liver to be processed into a mature cell; the cell travels to the thymus. The T-cell lymphocyte develops from a bone marrow stem cell. The Tcell lymphocyte has a special receptor on its surface. The T-cell lymphocyte increases the functioning of the B-cell.
REF: Cellular Involvement in the Immune Response, pages 82-83
OBJ: 3 a. Laboratory b. Differential c. Historical d. Therapeutic
62. In addition to a clinical diagnosis, which additional category is used in diagnosing aphthous ulcers?
ANS: C
The diagnosis of aphthous ulcers is made on the basis of their clinical appearance and a complete patient history. Laboratory results are not specific for any form of aphthous ulcer. The thoroughness and data collection of a differential diagnosis is not necessary to diagnose aphthous ulcers. A therapeutic diagnosis is not necessary to diagnose aphthous ulcers.
REF: Oral Immunologic Lesions and Diseases, page 89 OBJ: 12 a. Hives b. Dermatitis c. Dry socket d. Jaundice
63. What is the common name for urticaria?
ANS: A
Urticaria is also known as hives. Dermatitis (eczema) is the inflammation of the skin. Dry socket (alveolar osteitis) is a postoperative complication of tooth extraction. Jaundice (icterus) is an abnormal accumulation of bilirubin in the blood and manifested by a yellowish discoloration of the skin.
REF: Oral Immunologic Lesions and Diseases, page 89 OBJ: 14 a. Barbiturates b. Antihistamines c. Antidepressants d. Corticosteroids
64. What is the group of medications used to treat patients with urticaria and angioedema?
ANS: B
Antihistamines (e.g., Benadryl) are the standard drugs used to treat urticaria and angioedema. Barbiturates are not useful when treating urticaria and angioedema. Antidepressants are not needed when treating patients with urticaria or angioedema. Corticosteroids are not the drugs of choice when treating urticaria or angioedema.
REF: Oral Immunologic Lesions and Diseases, page 90 OBJ: 14 a. Gingival inflammation b. Periodontal disease c. Oral ulcers on the tongue and lips d. Xerostomia
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?
ANS: C
Oral lesions are usually ulcers that frequently form on the lateral borders of the tongue. Crusting and bleeding lips are also often seen. Gingival involvement with erythema multiforme is rare. Since gingival involvement is rare, periodontal issues are not common with erythema multiforme. Xerostomia is not an oral manifestation of erythema multiforme.
REF: Oral Immunologic Lesions and Diseases, page 91 OBJ: 15 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.
66. What is a clinical difference between lichen planus and linea alba?
ANS: C
Lichen planus can occur in numerous regions of the oral cavity, whereas linea alba is best seen on the buccal mucosa. Lichen planus is not removed with a gauze square. Lichen planus does not carry a blue appearance. Lichen planus may be associated with erosions, bullae, or ulcers. Linea alba is asymptomatic.
REF: Oral Immunologic Lesions and Diseases, page 92 OBJ: 16 a. Melanotic macules b. Dental caries c. Oral candidiasis d. Periodontal disease
67. Patients with Sjögren syndrome who experience xerostomia are at a high risk of the following conditions except one. Which is the exception?
ANS: A
Patients with Sjögren syndrome are not prone to the development of melanotic macules. Patients with xerostomia are at a high risk for the development of dental caries. Patients with xerostomia are at a high risk for the development of oral candidiasis. Patients with xerostomia are at a high risk for the development of periodontal disease.
REF: Autoimmune Disease With Oral Manifestations, page 97 OBJ: 19
68. 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.
ANS: B
Raynaud phenomenon is a disorder affecting the fingers and toes, usually triggered by cold and emotional stress. Raynaud phenomenon does not affect the joints of the patient. The lacrimal glands are not affected by Raynaud phenomenon. The eyelids are not affected by Raynaud phenomenon.
REF: Autoimmune Disease With Oral Manifestations, page 98 OBJ: 19 a. Lichen planus b. Angioedema c. Minor aphthous ulcers d. Mucous membrane pemphigoid
69. A person with SLE may have oral manifestations similar to which other condition?
ANS: A
Oral lesions appear as erythematous plaques or erosions with white striae radiating from the center, resembling lichen planus. Angioedema appears as a diffuse swelling of tissue caused by permeability of deeper blood vessels. Minor aphthous ulcers are discrete, punched-out, round to oval ulcers surrounded by a halo of erythema. Mucous membrane pemphigoid demonstrates desquamative gingivitis, which is a range of ulceration and erythema involving the marginal and attached gingiva.
REF: Autoimmune Disease With Oral Manifestations, page 99 OBJ: 19 a. SLE b. Pemphigus vulgaris c. Lichen planus d. Aphthous ulcers
70. Oral lesions accompanying skin lesions may occur in the following diseases except one. Which is the exception?
ANS: D
Aphthous ulcers are not seen on skin but may develop in the oral cavity. Oral lesions accompany skin lesions in about 25% of patients with SLE. Pemphigus vulgaris is a severe, progressive autoimmune disease that affects both the skin and mucous membranes. Several forms of lichen planus have been described. In addition to oral lesions, skin lesions of itching and pruritus have been noted.
REF: Autoimmune Disease With Oral Manifestations, page 87 OBJ: 19 a. Tobacco use b. Trauma c. Emotional stress d. Infection
71. What is the most common precipitating factor seen in the development of aphthous ulcers?
ANS: B
Trauma is the most commonly reported precipitating factor in the development of aphthous ulcers (e.g., toothbrush trauma, x-ray film or sensor placement, injection site of local anesthetics). Tobacco use is not considered a precipitating factor in the development of aphthous ulcers. Nonsmokers report aphthous ulcer development. Emotional stress has been suggested as a contributing factor of the development of aphthous ulcers. Infection is not typically associated with the development of aphthous ulcers.
REF: Oral Immunologic Lesions and Diseases, page 87 OBJ: 12 a. HIV b. Urticaria c. Pemphigus vulgaris d. Behçet syndrome
72. Acantholysis, or the dissolution of the intercellular bridges of the prickle cell layer of the epithelium, is an oral manifestation of which disease?
ANS: C
Pemphigus vulgaris is characterized by intraepithelial vesicle formation that results from breakdown of the cellular adhesion between epithelial cells, termed acantholysis. While HIV disease presents with numerous oral manifestations, acantholysis is not typically listed.
Urticaria appears as multiple areas of well-demarcated edema and erythema of the skin. Behçet syndrome is an autoimmune disease that presents with oral ulcers that are painful and recurrent.
REF: Autoimmune Disease With Oral Manifestations, page 101
OBJ: 19 a. Nikolsky sign b. Oral ulcers c. Ocular inflammation d. Genital lesions
73. Persons with Behçet syndrome suffer from the following symptoms except one. Which is the exception?
ANS: A
The Nikolsky sign is associated with finger pressure causing a cleavage in the intraoral epithelium, resulting in the formation of a bulla. This finding is associated with pemphigus vulgaris. Oral ulcers are seen in persons with Behçet syndrome. Ocular inflammation usually begins with photophobia and develops into conjunctivitis in persons with Behçet syndrome. Genital lesions are usually small yet painful and recurrent in persons with Behçet syndrome.
REF: Autoimmune Disease With Oral Manifestations, page 103
OBJ: 19
