Allergic and Immunologic Diseases of Oral Cavity

527. the nature of antigen in antigen- antibody reactions usually belongs to group of
a. protein
b. inorganic materials
c. glycolipids
d. nucleic acids

A

All cases of the allergy depends upon the combination of an antigen , usually but not always a protein or a polysaccharide , with an antibody produced b the host , almost invariably as a result of previous exposure to antigen .

528. recurrent apthous stomatitis in certain aspects of the clinical appearance, duration of lesions and chronic recurrence and general failure of response to any form of therapy mimics closely
a. hand, foot and mouth disease
b. herpangina
c. herpes simplex infection
d. any of the above

C

Recurrent apthous stomatitis is an unfortunately common disease characterized by the development of painful, recurring solitary or multiple ulcerations of the oral mucosa. There is similarity between recurrent apthous stomatitis and herpes simplex infection, with respect to precipitating factors leading to development of the lesions, certain aspect of clinical appearance of the lesions, duration of the lesion, chronic recurrence and general failure of response to any form of therapy.

529. the bacterial infection proposed to be one of the etiologic factor behind recurrent apthous stomatitis is
a. L form of streptococcus sanguis
b. L form of streptococcus mutans
c. L form of staphylococcus
d. R form of streptococcus sanguis

A

The work of Barile, of Graykowski and of Stanley very strongly implicated a pleomorphic transitional L- form of an alpha heamolytic streptococcus, Streptococcus sanguis, as the bacterial causative agent of the disease recurrent apthous stomatitis. The other etiological factors implicated are, deficiency of vitamin B 12 and folic acid and an abnormal auto immune response to pathogenically altered oral mucosa.

530. the etiology behind recurrent apthous stomatitis is
a. bacterial infection
b. immunologic abnormalities
c. vitamin B12, iron and folic acid deficiency
d. all of the above

D

The etiology behind recurrent apthous ulcer is bacterial infection, immunologic abnormalities, iron, vitamin B12 or Folic acid deficiency, and precipitating factors such as trauma, endocrine conditions, psychic factors, allergic factors.

531. the endocrinal hormones which are regarded as precipitating factors for recurrent apthous stomatitis are
a. testosterone
b. growth hormone
c. thyroxine
d. progesterone

D

Relationship exists between the occurrence of the menstural period and the development of the ulcers. Incidence of apthae is greatest during the premenstrual period. Dolby has shown similarity between that ulceration is maximal in the post-ovulation period and has related this to blood level of progesterone.

532. which form of recurrent apthous stomatitis is most commonly seen
a. recurrent apthous minor
b. recurrent apthous major
c. recurrent herpetiform ulcerations
d. recurrent ulcers associated with Bechet’s syndrome

A

Recurrent apthous ulcer has been classified into four main variants:
– Recurrent apthous minor, which is the most common form of the disease and the one referred to by the lay public as the ‘canker sore’.
– Recurrent apthous major
– Recurrent herpetiform ulceration
– Behcet’s syndrome

533. apthous ulcers begins their clinical course usually by
a. a prodromal phase causing fever, headache and lymphadenopathy
b. single or multiple superficial erosions covered by a gray membrane
c. vesicles formation
d. burning sensation and generalized edema of the oral cvity

B

The apthous ulcer begins as a single or multiple superficial erosions covered by a gray membrane. It generally has a necrotic center with clearly defined raised margins surrounded by an erythematous halo. They are usually not preceded by a phase of prodromal symptoms as opposed to the case for herpes simplex ulcerations

534. the chief clinical characteristics of recurrent apthous minor ulcers is/ are
a. occurrence on locations of labile mucosa not bound to periosteum
b. six or less lesions between 2- 3 to 10 mm in maximum diameter
c. persisting for 7- 14 days and heals with little or no scarring
d. all of the above

D

The lesion varies in size from 2-3mm to over 10mm in diameter. The most common site of occurrence are buccal and labial mucosa, buccal and lingual sulci , tongue , soft palate, phaynx, gingiva, and all locations of the labile mucosa not bound to the periosteum. The ulcers themselves generally persist for 7-14 days and then heal gradually with little or no evidence of scarring.

535. recurrent herpetiform ulcers can be differentially diagnosed from herpes simplex infection by
a. clinical findings
b. response to treatment
c. cytologic and microscopic findings
d. all of the above

C

In the ulcers of recurrent herpetiform, the herpes simplex virus cannot be cultured from the lesions or demonstrated by electron microscopy, although Sapp and Brooke have demonstrated non viral intranuclear bodies in adjacent epithelial cells. Also, cytologic smears fail to reveal the typical multinucleated epithelial gaint cells as found in herpetic lesions.

– The microscopic findings are nearly identical with those of recurrent apthous ulcer.
– Immunoflurorescent and serologic technique are negative for antibodies to herpes virus as well as oral epithelial. Hence both the diseases can be separated by means of cytologic and microscopic findings, as clinically both of these look essentially similar

536. the characteristic cells containing changes in the nuclei of epithelial cells taken by cytologic smears from around recurrent apthous ulcers are known as
a. tzanck cells
b. lipschutz’s bodies
c. hyaline cells
d. anitschkow cells

D

Wood and his associates have described characteristic changes in the nuclei of the epithelial cells taken by the cytologic smears from around recurrent apthous ulcers. These have been referred to Anitschkow cells and consists of cells with elongated nuclei containing a linear bar of chromatin with radiating processes of chromatin extending towards the nuclear membrane.

537. bechet’s syndrome is considered to be
a. an infectious disease
b. an auto immune disorder
c. an inflammatory disorder
d. a hereditary disorder

B

Behcet’s syndrome is an autoimmune disorder since there is high incidence of autoantibodies against oral mucosa and also exhibit a rise in immunoglobins in the oral mucosa and blood.

538. bechet’s syndrome can be differentiated from recurrent apthous ulcers by
a. clinical appearance of oral ulcers
b. presence of recurrent ocular and or genital ulcers
c. microbiological essays
d. all of the above

B

In recurrent apthous stomatitis , the oral ulcers are the only manifestation of the disease. In Behcet’s sndrome , at least two of the classic triad of the disease must be present , recurrent oral ulcer’s , recurrent genital ulcer’s and ocular inflammation.

539. Reiter’s syndrome clinically mimics
a. bechet’s syndrome
b. sutton’s disease
c. gonorrhea
d. syphilis

C

Reiter’s sndrome is associated with urethritis , balanitis , cunjunctivitis and mucocutaneous lesions. It is the most common complications of nonspecific urethritis and in fact , clinically mimics gonorrhea, although urethral discharge is negative for Neisseria

540. the component diseases of Reiter’s syndrome consists of
a. non- gonococcal urethritis
b. arthritis
c. conjunctivitis and muco cutaneous lesions
d. all of the above

D

Reiter’s sndrome is associated with non-gonococcal. urethritis , balanitis , conjunctivitis and mucocutaneous lesions. It is the most common complications of nonspecific urethritis and in fact, clinically mimics gonorrhea, although urethral discharge is negative for Neisseria. Male : female ratio 9:1.

541. sarcoidosis, a multi-system granulomatous disorder have been traditionally associated with
a. mycobacterium
b. treponema pallidum
c. herpes simplex virus
d. streptococci viridans

A

Sarcoidosis is described as a multi system granulomatous disease of unknown origin characterized by the formation of uniform, discerte , compact, non caseating epitheloid granulomas. It is more common in blacks than in whites. It has been traditionally associated with abnormal immune response to mycobacterium like microbes.

542. the test used to diagnose sarcoidosis is
a. tuberculin test
b. mantoux reaction
c. kveim- siltzbach test
d. tzanck smear test

C

An intra-cutaneous test for diagnosis of the sarcoidosis, the Kveim-Siltzbach test, has been devised utilizing a suspension of human known sarcoidal tissue as the test agent.

543. histopathologically lesions of sarcoidosis and tuberculosis can be differentiated by the
a. presence of nests of epitheloid cells with multinucleated giant cells in tuberculosis
b. presence of granulomatous nodules in sarcoidosis
c. fact that no acid fast organism can be demonstrated in sarcoidosis
d. presence of caseous necrosis in tuberculosis

C

Sarcoid lesion closely resemble proliferative non-caseating nodules of tuberculosis ,and the differential diagonosis is frequently difficult to establish, however, no acid fast organisms can be demonstrated in the tissue sections of sarcoidosis.

544. a characteristic clinical picture of chronic low grade fever with firm painless, usually bilateral enlargement of parotid glands, accompanied by inflammation of the uveal tracts of the eyes and cranial nerve involvement suggests a diagnosis of
a. sjogren’s syndrome
b. heerfordt’s syndrome
c. mikulicz disease
d. james ramsay hunt syndrome

B

Uveoparotid fever, uveoparotitis, Heefordt’s sndrome is considered by most investigator’s to be a form of sarcoidosis in which characteristically there is firm , painless, usually bilateral enlargement of the parotid glands accompanied b the inflammation of the uveal tracts of the eye and cranial nerve involvement.

545. the most common nerve involved by paralysis in uveoparotid fever is
a. 7th cranial nerve
b. 5th cranial nerve
c. 9th cranial nerve
d. 10th cranial nerve

A

Uveoparotid fever, uveoparotitis, Heefordt’s sndrome is considered by most investigator’s to be a form of sarcoidosis in which characteristically there is firm , painless, usually bilateral enlargement of the parotid glands accompanied b the inflammation of the uveal tracts of the eye and cranial nerve involvement. The most common nerve invovlement is unilateral or bilateral seventh nerve paralysis.

546.the diseases which can clinically appear like midline lethal granuloma is/ are
a. actinomycosis
b. squamous cell carcinoma
c. conventional lymphoma
d. any of the above

D

Midline lethal granuloma ( malignant granuloma, lethel granuloma, midline lethal granuloma, ulceration) , disease which may appear clinically as midline lethal granuloma:
1) INFECTIOUS DISEASES:
A) BACTERIAL
-a) Brucellosis
-b) Rhinoscleroma
-c) Leprosy
-d) Actinomycosis
-e) Tuberculosis
-f) Syphilis

B) FUNGAL
a) histoplasmosis
b) candidiasis
c) coccidiodomycosis
d) blastomycosis
e) rhinosporidiosis
f) phycomycosis

C) PARASITIC
a) leishmaniasis
b) myasis

2) NEOPLASTIC DISEASES:
A) Squamous cell carcinoma
B)Rhabdomyosarcoma
C) Polymorphic reticulosis/ lymphomatoid granulomatosis
D) Conventional lymphoma

3) INFLAMMATORY DISEASE OF UNKNOWN ETIOLOGY
A) WEGENER’S GRANULOMATOSIS
B) IDIOPATHIC MIDLINE DESTRUCTIVE DISEASE

547. the most common oral site involved in wegener’s granulomatosis is
a. lips
b. tongue
c. gingiva
d. palate

C

Involvement of gingiva has been most common lesion and characteristic manifestation OF WEGENER’S GRANULOMATOSIS and is termed as ‘strawberry gingivitis’

548. the clinical manifestations of Wegener’s granulomatosis closely resembles those of
a. midline lethal granuloma
b. chronic granulomatous disease
c. angioedema
d. sarcoidosis

A

Wegener’s granulomatosis is a disease of unknown etiology which is basically involves the vascular, renal and respiratory. It does has common features with the midline lethal granuloma, but is considered separate entity .it involves nose, para-nasal air sinuses , lower respiratory tract, gut, joint, nervous system , and kidney .

549. the death occasionally results from angioedema when there is
a. superimposed infections
b. immuno suppression in patient
c. involvement of GIT or respiratory tracts
d. associated systemic disease like diabetes mellitus

C

Angioedema, angioneurotic edema , quinke’s edema, gaint urticaria, is a diffuse edematous swelling of the skin , mucosa, and submucosal connective tissue. It results in death due to involvement of gastrointestinal and respiratory tracts.

550. quincke’s edema was also referred in past to as angioneurotic edema because
a. most patients were also suffering from hemangiomas
b. most patients presented with psychological problems
c. most patients reported with brain tumors
d. none of the above

B

Quinke, describing this disorder as early as in 1882, related the changes observed to an alteration in vascular permeability considering the fact that many angioedema patients present with psychological problems, it has been erroneously referred to as ‘ angioneurotic edema’ in past.

551. the ACE (angiotensin converting enzymes) inhibitors drugs used for treatment of hypertension may cause angioedema in some patients because of
a. the patient might be allergic to the drug
b. mast cells de-granulation caused by the drugs
c. increased level of bradykinins induced by the drug
d. IgE mediated hypersensitivity reactions

C

Cases of angioedema related to ACE inhibitors are not IgE – mediated and often do not respond to antihistamines and corticosteroids. ACE inhibitors causes angioedema by increasing the levels of bradykinin. It is a peptide with potent vasodilating action, causes rapid accumulation of fluid in the interstitium. This form of angoidema usually arises within hours of initial use of the drug.

552. in type I variant of hereditary form of angioedema, the basic defect lies in
a. quantitative reduction in inhibitor C1- INH, which prevents transformation of C1 to C1 esterase
b. qualitatively, non functionality of C1- INH
c. defect in enzyme C1 esterase
d. decreased formation of C4 and C2 from C1

A

Angioedema also result from activation of complement pathway. This may be hereditary or acquired. Two rare autosomal dominant hereditary forms include Type 1 and Type 2. Type 1 comprising 85% of hereditary cases, is caused by qualitative reduction in the inhibitor that prevents the transformation of C1 to C1 esterase. Without adequate levels of this inhibitor (C1-INH), C1 esterase cleaves C4 and C2 and results in angioedema. Type 2 exhibits normal levels of C1-INH, but the inhibitor is non-functional.

553. drug idiosyncrasy seen in some of the patients receiving particular drugs may be explained on basis of
a. toxic effects of the drugs
b. side effects of the drugs
c. exaggerated normal pharmacologic effects only developing after heavy dosages
d. drug allergy in sensitive patients

D

drug allergy includes a variety of sensitive reactions following the exposure to any one of a great many drugs and chemicals but is not related to any pharmacological activity or toxicity of these material. The common allergic reactions to systemic administration of a drug include skin lesions, arthralgia, fever, lymphadenopathy, and rarely agranulocytosis. Commonly drugs such as aspirin, barbiturates, chloramphenicol, tetracycline, pencillin, streptomycin and sulphonamides are implicated in allergic drug reations.

554. stomatitis medicamentosa is
a. an allergic reaction of the oral mucosa to the systemic administration of a drug
b. a toxic reaction of the oral mucosa to the systemic administration of a drug
c. a caustic reaction of the oral mucosa to the local application of a drug, such as aspirin burns
d. oral ulcerations induced as a result of pharmacologic effects of drugs on systemic administration

A

Drug allergy (drug idiosyncrasy, drug sensitivity, and stomatitis or dermatitis medicamentosa) includes a variety of sensitivity reactions following exposure to any one of a great many drugs and chemicals but is not related to any pharmacologic activity or toxicity of these materials. The common allergic reactions to systemic administration of a drug include skin lesions, arthralgia, fever, lymphadenopathy, and rarely agranulocytosis.

555. the most common type of allergic reaction of oral mucosa to systemic administration of drugs is
a. gingival hyperplasia
b. lichenoid drug reactions
c. erythema multiforme
d. intra oral fixed drug eruptions

C

Erythema multiforme is a blistering, ulcerative mucocutaneous condition of uncertain etiopathogenesis. Drugs and medication particularly antibiotics or analgesics may trigger the immunologic derangement that produces the disease. The lips, labial mucosa, buccal mucosa, tongue, floor of the mouth and soft palate are most common sites of involvements. Sub-epithelial or intraepithelial vesiculation may be seen in association with necrotic basal keratinocytes.

556. frequency of a true allergic reaction to any one antigen appears to be rarer in oral mucosa as compared to that of skin, this is largely attributed to the fact that
a. saliva dilutes and removes many antigens
b. lower density of langerhans cells and T lymphocytes in oral mucosa
c. shorter period of contact of allergen to oral mucosa in the oral cavity
d. all of the above

D

The oral mucosa is much less sensitive than the surface of the skin; this is most likely because of the following:
The period of contact is often brief.
The saliva dilutes, digests, and removes many antigen.

The limited keratinization of oral mucosa makes hapten binding more difficult, and the high vascularity tends to remove any antigen quickly.
The allergen may not be recognized ( because of the lower density of Langerhans cells and t lymphocyte.