1
Q
Which type is Type I hypersensitivity?
A
Immediate
2
Q
Which type is Type II hypersensitivity?
A
Cytotoxic
3
Q
Which type is Type III hypersensitivity?
A
Immune-complex
4
Q
Which type is Type IV hypersensitivity?
A
Delayed
5
Q
Which type is Type V hypersensitivity?
A
Autoimmunity
6
Q
What mediates Type I hypersensitivity
A
IgE antibodies
7
Q
What mediates Type II hypersensitivity
A
IgG, IgM
8
Q
What mediates Type III hypersensitivity
A
IgG, IgM
9
Q
What mediates Type IV hypersensitivity
A
T cell
10
Q
What mediates Type V hypersensitivity
A
Receptor
11
Q
2 examples of a Type I hypersensitivity reaction
A
Anaphylaxis
Asthma
12
Q
1 example of a Type II hypersensitivity reaction
A
Transfusion reaction
13
Q
1 example of a Type III hypersensitivity reaction
A
Systemic lupus erythematosus
14
Q
2 examples of a Type IV hypersensitivity reaction
A
Orofacial granulomatosis
Organ rejection
15
Q
2 examples of a Type V hypersensitivity reaction
A
Myasthenia gravis
Pernicious anaemia
16
Q
Define orofacial granulomatosis
A
Inflammatory non-caseating granulomatous disorder
17
Q
How common is orofacial granulomatosis
A
Uncommon
18
Q
Is Primary (Idiopathic) or Secondary (to e.g., Crohn’s) orofacial granulomatosis more common
A
Primary
19
Q
4 clinical features of orofacial granulomatosis
A
Lip swelling
Sublingual folds oedematous
Cobblestoning
Mucosal tags
20
Q
3 pathological features of orofacial granulomatosis
A
Lymphangiectasia
Lymphoedema
Non-caseating granulomata
21
Q
3 identified allergens associated with orofacial granulomatosis
A
Benzoic acid (E 210-219)
Cinnamonaldehyde
Chocolate
22
Q
3 methods of diagnosing orofacial granulomatosis
A
Buccal mucosal biopsy
Haematology investigation: FBC to test for anaemia
Patch testing
23
Q
3 managements of orofacial granulomatosis
A
Cinnamon and Benzoate free diet
Steroids: mouthwash, creams/ointments, systemic steroids
Immunosupressants: calcineurin inhibitors
24
Q
Define erythema multiforme
A
A potentially fatal, muco-cutaneous disorder with an allergic basis
25
3 pathological features of erythema multiforme
Liquefactive degeneration of basal cells in the epidermis
Necrotic keratinocytes
Exocytosis of lymphocytes
26
Define Human Immunodeficiency Virus (HIV)
Human Retrovirus (Lentivirus family) that weakens the immune system and increases the risk of serious illness
27
3 pathological features of HIV
gp120 binds to CD4 receptor, reverse transcribes RNA into DNA
Long latency
Profound effects on immune cell function
28
2 clinical features of primary HIV infection
Clinically well, asymptomatic
Progressive generalised lymphadenopathy
29
Define Acquired Immune Deficiency Syndrome (AIDS)
Severe cell mediated immune defect occurring in a HIV+ patient in whom there is no other known cause of immunosuppression
30
4 clinical features of AIDS
Low-grade pyrexia
Persistent lymphadenopathy
Night sweats
Weight loss
31
CD4 T-cell count of an AIDS patient
Less than 200 x 10^6 cells per litre
32
4 lab investigations for AIDS
CD4 T-cell count
CD4:CD8 inversion
Thrombocytopenia
HIV antibodies
33
5 immune consequences of AIDS
T-cell paralysis
Polyclonal B-cell stimulation
Opportunistic infections
Tumours: Kaposi’s sarcoma (HHV8), NH Lymphoma (EBV)
Autoimmune conditions
34
Management of AIDS
Reduce circulating viral load to allow recovery of immune function with HAART
35
5 specific oral manifestations of AIDS
Oral candidosis
Hairy leukoplakia
Acute ulcerative gingivitis (AUG)
Kaposi’s sarcoma
Non-Hodgkin’s lymphoma
36
2 features to aid in the diagnosis of AIDS
2 specific oral manifestations
SPUR (serious, persistent, unusual, recurrent) infections
37
Describe orofacial pigmentation
Common, usually harmless condition in which patches of mucosa become darker in colour due to melanin, blood, medication or a foreign body
38
3 epidemiological features of inherited physiological pigmentation
African or Asian heritage
Affects all ages
M=F
39
4 clinical features of inherited physiological pigmentation
Brown/dark patches
Symmetrical distribution
Homogeneous
Anterior labial/palatal mucosa
40
Management of inherited physiological pigmentation
No treatment usually required
41
2 clinical features of habitual local pigmentation
Typically affects tongue and teeth
Easily removed
42
2 clinical features of foreign body tattoo pigmentation
Asymptomatic
Solitary blue/black/grey macule
43
2 ways to diagnose foreign body tattoo pigmentation
Radiographs: amalgam particles may be visible on IOPA
Biopsy (atypical presentation)
44
Clinical presentation of black hairy tongue
Brownish-black coating of the dorsal surface of the tongue
45
Management of black hairy tongue
Conservative
46
2 epidemiological features of melanotic macule
1:1000 adults
M=F
47
Clinical presentation of melanotic macule
Usually small <1cm solitary lesion lower lip, anterior gingiva, buccal mucosa, palate
48
Clinical presentation of vascular malformation
Well circumscribed flat or raised blue coloured lesions
49
Diagnosis of vascular malformation
Diascopy
50
3 treatment options for vascular malformation
Surgically excised
Cryotherapy
Sclerosing agents
51
Clinical presentation of smokers melanosis
Diffuse pigmentation affecting anterior labial gingiva, palate and buccal mucosa
52
Epidemiological feature of post inflammatory pigmentation
More common in darker skinned persons
53
Clinical presentation of post inflammatory pigmentation
Single or multiple brown-black patches
May persist for a long time after the resolution of the inflammatory process
54
Clinical presentation of medication related pigmentation
Multiple brown lesions palate, buccal mucosa and gingiva
55
Management of medication related pigmentation
May resolve with discontinuation of medication
56
Define Peutz-Jeghers syndrome
Autosomal dominant condition with an increased risk of gastrointestinal malignancy
57
2 clinical presentations of Peutz-Jeghers
Numerous pigmented lesions on lips, buccal mucosa, palms and soles
Intestinal polyps
58
Define thrombocytopenia
Reduction in number of circulating platelets: inadequate production, increased destruction, splenic sequestration
59
4 clinical presentations of thrombocytopenia
Petechiae and purpura of mucosa
Tendency to bruise
Spontaneous bleeding
Blood in stools/urine
60
Method of diagnosing thrombocytopenia
Blood count and film
61
Management of thrombocytopenia
Identification and correction of underlying cause
62
Define Sturge-Weber syndrome
Vascular defect associated with the distribution of one or more branches of the trigeminal nerve
63
2 clinical presentations of Sturge-Weber syndrome
Port wine stain appearance of the skin of the face
Intra-oral gingiva and soft tissues appear blue and swollen
64
Define hereditary hemorrhagic telangiectasia
Autosomal dominant condition causing dilatation of terminal blood vessels of skin and mucous membranes
65
Clinical feature of hereditary hemorrhagic telangiectasia
Small red or purple spots on the skin and lips
66
How common is hereditary hemorrhagic telangiectasia
Rare
67
Describe Addison’s disease
Disorder of the adrenal glands, causing insufficient production of cortisol and aldosterone
68
How common is Addison’s disease
Rare
69
4 clinical presentations of Addison’s disease
Lethargy
Weight loss
Postural hypotension
Hyperpigmentation of buccal mucosa
70
Describe malignant melanoma
Malignant neoplasm of melanocytes
71
3 epidemiological features of malignant melanoma
Uncommon
Middle aged
M>F
72
5 year survival rate of malignant melanoma
Poor, 5-50%
73
Clinical presentation of malignant melanoma
Usually asymptomatic
Irregular, dark (black, brown, blue) lesion
74
2 ways to diagnose malignant melanoma
Biopsy
Imaging
75
2 managements of malignant melanoma
Surgical excision
Adjunctive therapy
76
Define vesiculobullous disorders
Mucocutaneous disorders characterised by blister (bulla) formation, vesicles, ulcers, erosions
77
3 examples of immune mediated vesiculobullous disorders
Erythema multiforme
Pemphigus vulgaris
Mucous membrane pemphigoid
78
3 examples of conditions that cause sub-epithelial bullae
Erythema multiforme
Mucous membrane pemphigoid
Angina bullosa haemorrhagica
79
1 example of an intraepithelial bullous disorder
Pemphigus vulgaris
80
3 epidemiological features of erythema multiforme
Uncommon
Young adults
M>F
81
5 aetiological features of erythema multiforme
Genetics
Microorganisms
Drugs
Chemicals
Immune factors
82
3 clinical features of erythema multiforme
Serosanguinous exudate on lips
Target lesions
Widespread mucosal ulceration
83
3 diagnostic methods for erythema multiforme
Clinical
Serology
Biopsy
84
3 managements for erythema multiforme
Supportive care as self limiting: antiseptic mouthwashes, antimicrobials
Topical/systemic steroids
Acyclovir prophylaxis (recurrent cases)
85
3 epidemiological features of angina bullosa haemorrhagica
Uncommon
Older age groups
F>M
86
2 aetiological features of angina bullosa haemorrhagica
Trauma
Corticosteroid inhalers
87
2 clinical features of angina bullosa haemorrhagica
Rapid onset of blood filled blister formation on soft palate and lateral borders of tongue
Break down to form large, painful ulcers
88
2 diagnostic methods for angina bullosa haemorrhagica
Clinical presentation
Bloods
89
3 managements for angina bullosa haemorrhagica
Reassurance
Maintain airway
Analgesics
90
3 epidemiological features of mucous membrane pemphigoid
Uncommon
>50 years
F>M
91
Aetiology of mucous membrane pemphigoid
Unknown
92
4 clinical features of mucous membrane pemphigoid
Mucosal pain
Tense bullae or vesicles which rupture to produce irregular erosions
Ocular, skin, genital involvement
Associated with desquamative gingivitis
93
Describe the pathogenesis of mucous membrane pemphigoid
Autoantibodies are directed against epithelial basement membrane zone proteins which result in split at basement membrane
94
3 diagnostic methods for mucous membrane pemphigoid
Clinical presentation
Biopsy
Immunofluorescence: sub epithelial split
95
3 managements of mucous membrane pemphigoid
Good oral hygiene
Steroids
Immunosuppressants: Azathioprine, Mycophenolate mofetil
96
3 epidemiological features of pemphigus vulgaris
Rare
40-60 year olds
M=F
97
Aetiology of pemphigus vulgaris
Unknown
98
4 clinical features of pemphigus vulgaris
Fragile bulla
Large painful irregular erosions
Skin involvement
Associated with desquamative gingivitis
99
Describe the pathogenesis of pemphigus vulgaris
Antibodies are directed against desmosomes causing acantholysis
100
4 managements of pemphigus vulgaris
Good oral hygiene
Steroids
Immunosuppressants: Azathioprine, Mycophenolate mofetil
Referral as potentially life-threatening
101
4 diagnostic methods for pemphigus vulgaris
Clinical presentation
Biopsy
Immunofluorescence: intraepithelial split
Histology: tomb stone appearance
102
Describe immunofluorescence
Diagnostic technique that uses antibodies to label a specific target antigen with a fluorescent dye
103
Describe 3 features of a direct immunofluorescence test
Perilesional tissue sample
1 stage as antibody binds to the target antigen
Less sensitive test than indirect
104
Describe 3 features of an indirect immunofluorescence test
Serum sample
Two stage process
More sensitive
