Term
| The skin has (high/low) pH to combat bacteria, and the genito-urinary tract has __________ to outcompete other bacteria. |
|
Definition
|
|
Term
|
Definition
| AKA Placental fetal transmission |
|
|
Term
| Mechanisms of adhesion for bacteria...... |
|
Definition
| Lipoteichoic acid (N. gonorrhoeae and S. pyogenes) and M protein (S. pyogenes). |
|
|
Term
| Mechanism of exotoxin for bacteria...... |
|
Definition
| AB toxins of Anthrax; also superantigens. |
|
|
Term
| The etiologic agent for syphilis. |
|
Definition
| Treponema pallidum; resistant to phagocytosis (although there are no known endotoxins or exotoxins); seen in DARK FIELD MICROSCOPY; does not cause direct lysis of cells (eventually see a lymphocyte response); OCCUPATIONAL HAZARD FOR DENTISTS! |
|
|
Term
| Chancres are normally seen on.......... |
|
Definition
| Genitalia 98% of the time (oral lesions are normally on the lip); histologically, we see periarteritis and endarteritis(cuts off blood supply). |
|
|
Term
| __% of syphilis patients progress to the secondary phase; 2-3 months after the chancre we see generalized papular lesions on the skin and mucous patches (HIGHLY CONTAGIOUS). |
|
Definition
|
|
Term
| Papillary lesions in seconday syphilis that resemble viral papillomas. |
|
Definition
|
|
Term
| Explosive and widespread form of secondary syphilis in immunocompromised patients. |
|
Definition
|
|
Term
| Immune complexes formed in secondary syphilis may progress to ____________ or ____________. |
|
Definition
| Transient arthritis or glomerulonephritis. |
|
|
Term
| __% of patients with secondary syphilis progress to tertiary syphilis 5-30 years later; no overt clinical signs of disease; cannot infect others except via placental transfer. |
|
Definition
|
|
Term
| The biggest complication of tertiary syphilis. |
|
Definition
| Cardiovascular problems due to endarteritis obliterans causing aortic aneurysm and MI (80%); 10% have neurosyphilis (anterior spinal artery which can cause tabes dorsalis and primary optic nerve atrophy), and 10% have benign tertiary syphilis (gummas in organs). |
|
|
Term
| In patients with tertiary syphilis, ____________ causes general paresis. |
|
Definition
| Cerebral cortex invovlement; it is common to find spirochetes in these lesions. |
|
|
Term
| Intraoral gummas usually affect the ___________ and __________. |
|
Definition
| Palate (perforation) and tongue (interstitial glossitis- large, lobulated, and irregular in shape); treatment with arsenic can lead to luetic glossitis (loss of dorsal tongue papillae). |
|
|
Term
| Gummas are defined by...... |
|
Definition
| A central area of coagulative necrosis surrounded by lymphocytes, giant cells, and fibrous tissue. |
|
|
Term
| Early congenital syphilis |
|
Definition
| Appears within 2 years of birth; skip chancre and go straight to secondary syphilis; progress to tertiary syphilis. |
|
|
Term
|
Definition
| Develops after 2 years of age; similar to tertiary syphilis. |
|
|
Term
|
Definition
1) interstitial keratits (corneal inflammation)
2) deafness
3) Hutchinson's incisors
Saddle nose is also common with congenital syphilis. |
|
|
Term
| To see if you've ever had syphilis, you need a _____________ test. |
|
Definition
| High-sensitivity with FTA-ABS or TPHA; is positive, need to see if it's active via a low-sensitivity test with RPR or VDRL. |
|
|
Term
|
Definition
| C. diptheriae is a gram+ rod that produces AB toxin; blocks host cell protein synthesis; ADP-ribosylating causes inactivation of more than a millions EF-2 molecules; the A fragment of the toxin is responsible for catalyzing the transfer of ADP-ribose to EF-2. |
|
|
Term
|
Definition
| Grayish necrotic area on tonsils! Also, anorexia, vomiting, lymphadenopathy (bull neck); in severe cases, myocarditis and neurologic involvement (paralysis of oculomotor, pharyngeal, diaphragm, and intercostal muscles). |
|
|
Term
|
Definition
| Penicillin and anti-toxin; infection does not confer immunity; only cured when you have three straight negative cultures of the lesion. |
|
|
Term
| Gram+ cocci; many lead to suppurative infections of the skin, oropharynx, lungs, and heart valves. |
|
Definition
|
|
Term
| Group A streptococci appear like this on the culture plate...... |
|
Definition
| Non-motile, non-spore-forming organisms that form a 1-2mm culture on the plate surrounded by zones of complete hemolysis; some colonies produce hyaluronic acid, which appears as mucoid on the plate. |
|
|
Term
| Beta-hemolytic streptococci are classified on the basis of........ |
|
Definition
| M-protein precipitin reactions. |
|
|
Term
| Group A streptococcal infections are associated with ___________ and _____________. |
|
Definition
| Acute rheumatic fever (ARF) and glomerulonephritis; also toxic shock syndrome (TSS) with group A streptococci tonsillopharyngitis. |
|
|
Term
| Gram+ cocci; many lead to suppurative infections of the skin, oropharynx, lungs, and heart valves. |
|
Definition
|
|
Term
| A hemolytic toxin produced by GAS; antibodies to this are an indicator of recent infection; inactivated by oxygen; it is a single chain protein that induces a brisk antibody response. |
|
Definition
|
|
Term
| Produced by the bacteria in the presence of serum; non-antigenic; it is a polypeptide that has lytic effects for RBCs and WBCs (responsible for the hemolysis seen on culture plates). |
|
Definition
|
|
Term
| A toxin produced by GAS that destroys the hyaluronic acid in connective tissue. |
|
Definition
|
|
Term
| Produced by GAS and are responsible for fever, scarlet fever rash, and TSS; produce cardiac and hepatic necrosis in animals; depress antibody synthesis while stimulating T-cell proliferation (superantigens). |
|
Definition
|
|
Term
| Toxins produced by GAS that assist in the liquefaction of pus and help to generate substrate for growth. |
|
Definition
| Deoxyribonuclease A, B, C, and D |
|
|
Term
| Two streptokinases produced by GAS serve to...... |
|
Definition
| Form complexes with plasminogen activator and catalyze the conversion of plasminogen to plasmin (leading to digestion of fibrin). |
|
|
Term
| With streptococcal tonsillitis/pharyngitis, we usually don't see ________, _________, or ____________. |
|
Definition
| Rhinitis, laryngitis, or bronchitis - testing for strep should be discouraged if we see these; 25% of these cases are caused by Group A, beta-hemolytic streptococci. |
|
|
Term
| Scarlet fever starts out with _______ tongue but progresses to ______ tongue by day 4. |
|
Definition
| White strawberry tongue......strawberry tongue (prominence of fungiform papillae); Pastia's lines also seen at this point; "sunburn with goosebumps" rash that spares the palms, soles, and face; caused by an erythrogenic exotoxin; skin desquamates for up to 8 weeks after the rash clears. |
|
|
Term
| Etiologic agent of impetigo |
|
Definition
| S. pyogenes (different strain than the one causing tonsillitis) or S. aureus causing a superficial skin infection; usually arises over previous trauma or dermatitis. |
|
|
Term
| Two forms of pruritic lesions that occur with impetigo: |
|
Definition
1) Fragile vesicles that erupt to form adherent amber crusts
2) Longer lasting bullous lesions that form honey-colored crusts (S. aureus associated)
Mistreatment with corticosteroids will reduce crusts but not clear the red raw lesions. |
|
|
Term
| AKA St. Anthony's Fire, Egyptian Healer, or French Hospital with Red Walls; can be confused with facial cellulitis from a dental infection; "orange peel" butterfly lesion similar to SLE; cultures are not beneficial; gangrene may be a complication. |
|
Definition
|
|
Term
| Poststreptococcal glomerulonephritis is usually caused by GAS types __ and __. |
|
Definition
| 12 and 49; more common in children with skin infections than pharyngitis; probably due to immune complex deposition within the glomerulus. |
|
|
Term
| __ and __ types of M-protein are associated with TSS. |
|
Definition
| 1 and 3; associated with streptococcal pyrogenic exotoxins A, B, and C as well as streptococcal superantigen. |
|
|
Term
| Which two types of hepatitis are the most significant clinical diseases? |
|
Definition
| B and C; present in all body fluids except stool; Hepatitis B has infected about 2 billion people throughout the globe. |
|
|
Term
| Over __% of patients with acute hepatitis B do not have any readily identifiable risk factors. |
|
Definition
| 30%; hepatitis B has one of the smallest genomes of all viruses. |
|
|
Term
| _____ is a core protein (antibodies to this do not help to clear the infection; only serve as a marker for infection) and ______ is a longer polypeptide with a precore and core region (present with clinical onset and disappears 2 weeks after; immune complexes with antibodies for this can cause glomerulonephritis, arteritis, and arthritis). |
|
Definition
|
|
Term
| A viral protein expressed in the surface of the hepatocyte; T-cell then induces apoptosis via TNF, etc with the help of Fas ligand; it is detected 2 months to 2 weeks before clinical onset, and antibodies to it provide lifelong immunity. |
|
Definition
|
|
Term
| A protein from a region of hepatitis B that may play a role in the causation of hepatocellular carcinoma. |
|
Definition
|
|
Term
| Of the patients with acute hepatitis, __% go on to fulminant hepatitis. |
|
Definition
| 1%; the other 99% make a recovery. |
|
|
Term
| Of the 4% of patients that have chronic persistent hepatitis, _______% become chronic active. |
|
Definition
| 10-33%; of these people, 20-50% develop cirrhosis/hepatocellular carcinoma; many chronic carriers have virions in their hepatocytes with no evidence of cell injury. 70-90% of people with chronic persistent hepatitis go on to make a recovery. |
|
|
Term
| 4 stages of acute hepatitis |
|
Definition
1) Incubation
2) Pre-icteric- when you become jaundiced (not common in children.....50% of adults become jaundiced).
3) Icteric (fever, malaise, loss of appetite, vomiting).
4) Convalescence |
|
|
Term
| A finding in hepatitis where bile plugs (canaliculi) and brown pigmentation are seen in the hepatocytes; there is also ballooning degeneration of the hepatocytes. |
|
Definition
|
|
Term
| Two patterns of hepatocyte death in hepatitis: |
|
Definition
1) Cytolysis- necrotic cells have "dropped out"
2) Apoptosis- intensely eosinophilic and fragmented nuclei |
|
|
Term
| Fatty change is associated with hepatitis __. |
|
Definition
|
|
Term
| _________ is often seen in Kupffer cells which have undergone hypertrophy and hyperplasia from hepatitis. |
|
Definition
| Lipofuscin (from phagocytosis of hepatocellular debris). |
|
|
Term
| Inflammation during hepatitis mainly occurs in the ________ region of the hepatocyte. |
|
Definition
|
|
Term
| The main cause of death with fulminant hepatitis |
|
Definition
| Cerebral edema due to decreased osmolarity of blood; there is massive hepatic necrosis with collapse of the reticulin framework; liver is shrunken to as little as 500g! Surprisingly we may not see much inflammation until the cleanup process occurs days later. |
|
|
Term
| ________ and ________ are most susceptible to chronic hepatitis. |
|
Definition
| Children (mother to infant) and men (women more likely to get autoimmune hepatitis); also, homosexual orientation and altered immune function increase chances. |
|
|
Term
| During chronic persistent hepatitis, _______ levels are high but there is little viral replication. |
|
Definition
| HBsAg levels are high; we see "Ground Glass Hepatocytes"; inflammation is limited to portal tract region with Kupffer cells appearing normal and serum aminotransferase levels being low. |
|
|
Term
| During chronic active hepatitis, we see........ |
|
Definition
| Fibrotic strands linking portal tracts to central vein (cirrhosis!); "piecemeal necrosis" (inflammation around portal tracts making them look irregular) is a hallmark of progressive disease. |
|
|
Term
| Hepatocellular carcinoma develops in __% of patients with __________. |
|
Definition
| 20% of patients with cirrhosis regardless of whether it's from HBV or not; carcinoma is far more likely to occur in individuals exposed to HBV in childhood or infancy. |
|
|
Term
| _________ after birth reduces hepatitis B infection by 95% |
|
Definition
| HBsAg immunoglobulin (antiserum?) |
|
|
Term
| An explosive form of HPV where warts cover the entire body (genetically related); 30% chance of developing malignancy (higher with trauma or sun exposure). |
|
Definition
| Epidermodysplasia verruciformis |
|
|
Term
| Small, non-enveloped icosahedral viruses; most common human viral infection! |
|
Definition
|
|
Term
| HPV initially infects __________; mature virions are shed from the ____________ layer. |
|
Definition
| Basal cells in the epithelium......stratum corneum. |
|
|
Term
| Characteristic perinuclear vacuolization in epithelial cells due to HPV. |
|
Definition
|
|
Term
| HPV DNA is maintained as an _____________. |
|
Definition
| Episomal plasmid; however, some HPV DNA integrate into the cell's DNA (smoking, oral contraceptives, STDs) and can cause malignancy! |
|
|
Term
| HPV enters the carcinogenesis pathway by......... |
|
Definition
| Inactivating tumor suppressors p53 (via E6) and pRb (via E7 to prevent Rb's interaction with E2F transcription factors to allow virus entry). |
|
|
Term
| The majority of HPV infections are ________. |
|
Definition
| Latent with no visible lesions; acetic acid can show keratinized tissue in a wart. |
|
|
Term
| Genital warts; most common benign genital tumor; associated with HPV 6 and 11 (same as for oral lesions!); laryngeal papillomas are a rare condition found in both adults and children. |
|
Definition
|
|
Term
| HPV types most commonly associated with cervical cancer..... |
|
Definition
| 16, 18, 31, and 35; 16 is the most dangerous with deletions of 3p and amplification of 3q in a chromosome; HPV can also prevent replicative senescence by upregulating telomerase via E6. |
|
|
Term
|
Definition
| DNA hybridization; currently there are no serological markers |
|
|
Term
| Mechanism of Epstein Barr Virus........ |
|
Definition
| The EBV envelope contains a glycoprotein that binds C3d complement on B cells; B-cells are the main reservoir in latent infections; during active infection these B cells are lysed. |
|
|
Term
| T cell appearance during EBV....... |
|
Definition
| Abundant cytoplasm, multiple clear vacuoles, and an oval, indented, or folded nucleus; cytoplasmic azurophilic granules; EBV is diagnosed with a peripheral blood smear. |
|
|
Term
| Enlarged spleen from EBV in the follicles and red pulp sinusoids can lead to ___________; in the liver, elevated lymphocyte levels can cause ____________. |
|
Definition
| Thrombocytopenia (increased bleeding time!)........parenchymal necrosis (CNS edema possible). |
|
|
Term
| Most EBV infections have a ___________ phase. |
|
Definition
| 2-week prodromal phase; except in infants and toddlers who are asymptomatic (developing countries); these latent people have polyclonal activation/proliferation of B-cells. |
|
|
Term
| Only give corticosteroids to treat EBV if there is ______________. |
|
Definition
| Airway obstruction (we need the immune system to overcome the virus); only give non-aspirin anti-pyretics. |
|
|
Term
| AIDS patients can experience this complication from EBV. |
|
Definition
| Life-threatening polyclonal B-cell proliferation (do not give corticosteroids!) |
|
|
Term
| Histoplasmosis capsulatum has _____________ phase at body temperature and __________ phase in its natural environment. |
|
Definition
| Haploid unicellular phase...........mold-like phase. |
|
|
Term
| A self-limited pulmonary infection with symptoms similar to the flu. |
|
Definition
|
|
Term
| Chronic histoplasmosis usually affects....... |
|
Definition
| Elderly, emphysematous, or immunosuppressed individuals; much less common than acute histoplasmosis; reminiscent of TB; 20% mortality if left untreated. |
|
|
Term
| Only occurs in 0.5% of patients with acute histoplasmosis; same type of people that get chronic histoplasmosis; oral lesions may be white or erythematous; solitary, variably painful ulcerations in the mouth; some larger oral lesions have firm, rolled margins that may look like malignancy; mortality is 90% if untreated (Amphotericin B!!!) |
|
Definition
| Disseminated histoplasmosis |
|
|
Term
| A Grocott-Gomori stain will make the field _________ with the fungi appearing ________. |
|
Definition
| Silver.....black; a Periodic Acid Schiff stain will also make the fungi stand out; fungi have their own nuclei and cell bodies. |
|
|
Term
| Treatment for histoplasmosis..... |
|
Definition
| Antifungal agents (Amphotericin B but causes kidney toxicity, ketoconazole, itraconazole). |
|
|
Term
| Two phases of candida albicans |
|
Definition
| Yeast and hyphal (more invasive); part of normal oral flora in 30-50% of people. |
|
|
Term
| AKA thrush; creamy white removable plaques; burning sensation; foul taste; often caused by antibiotic therapy and immunosuppression. |
|
Definition
| Pseudomembranous candidiasis |
|
|
Term
| Erythematous candidiasis can occur from........... |
|
Definition
| Denture stomatitis (not a true infection since it's only on the denture) or angular cheilitis (most often S. aureus); in acute atrophic candidiasis, we see red macules with loss of filiform papillae on the tongue ("scalded tongue"); caused by too many antibiotics. |
|
|
Term
| A form of erythematous candidiasis that is similar to central papillary candidiasis; "kissing lesion" between tongue and hard/soft palate; caused by immunosuppression or is idiopathic. |
|
Definition
| Chronic multifocal candidiasis |
|
|
Term
|
Definition
| A test used to determine denture stomatitis; denture will show organismal growth while mucosa will not. |
|
|
Term
| White plaques that are not removable; not a true leukoplakia because it cures with anti-fungals; patient is asymptomatic. |
|
Definition
|
|
Term
| Thick white patches that do not rub off, but lesion also has many characteristics of erythematous and pseudomembranous candidiasis at the same time; associated with immunologic disorders leading to autoimmunity (a recessive genetic form has also been found); the autoimmunity usually targets endocrine glands (we see the candidiasis first though!). |
|
Definition
| Mucocutaneous candidiasis |
|
|
Term
| _____ shows loss of rete ridges while ____ has elongated rete ridges. |
|
Definition
| HPV.....mucocutaneous candidiasis. |
|
|
Term
| Actinomycosis is normally caused by these two bacteria: |
|
Definition
1) A. israelii
2) A. viscosis
Filamentous, branching Gram+ bacteria that are part of the normal oral flora. |
|
|
Term
| Characteristics of actinomycosis infection....... |
|
Definition
| Painless, indurated swelling that doesn't follow normal facial spaces; SULFUR GRANULES surrounded by neutrophils form a GRANULOMA; associated with fibrosis. |
|
|
Term
| Actinomycosis lesions demonstrate...... |
|
Definition
| Both acute and chronic inflammation at the same time; organisms surrounded by PMNs which are surrounded by chronically inflamed granulation tissue that is surrounded by fibrosis; organisms within the abscess form a rosette pattern. |
|
|
Term
| Treatment for actinomycosis |
|
Definition
| 6 weeks of antibiotics if caught early; up to a year if late! Need to penetrate fibrosis; this disease is non-transmissible. |
|
|
Term
|
Definition
| Multiple Endocrine Neoplasia 2B; mucosal neuromas on tongue and lips (pathognomic for this disease); medullary thyroid cancer, pheochromocytoma, hypotonia, loose joints, and long face. |
|
|
Term
|
Definition
| Defect in phenylalanine hydroxylase causing production of various toxic secondary metabolites (autosomal recessive); eczema, severe mental retardation, seizures and neurologic abnormalities. |
|
|
Term
|
Definition
| Cancer susceptibility genes that are autosomal dominant. |
|
|
Term
| A "gain of function" autosomal dominant disease is ____________ while ___________ is a "loss of function." |
|
Definition
Achondroplasia.........Marfan Syndrome.
Huntington's Disease is caused by a "gain of function" toxic protein. |
|
|
Term
| Defect in DSG1 gene; blue/brown or opalescent teeth; pulp chambers may be absent. |
|
Definition
| Dentinogenesis imperfecta type II |
|
|
Term
| FGF-3 defect, trident hand, prominent brow, depressed bridge of nose, and small foramen magnum; dental malocclusion with an anterior overbite! |
|
Definition
|
|
Term
| The gene mutation that causes achondroplasia is simply a.......... |
|
Definition
| Single mutation of a glycine to an arginine in fibroblast growth factor 3 (FGF-3); it is the most mutable single base in the human genome. |
|
|
Term
| Mutation of Fibrillin 1 or 2; narrow mouth with high palate (crowded teeth); off-center lens in the eye and myopia; decreased elasticity of lung tissue, blood vessels, and heart valves (AORTIC DISSECTION!); caved-in or pushed-out breastbone; prominent stretch marks from growth. |
|
Definition
Marfan Syndrome
Give beta blockers to decrease the blood pressure to prevent aortic rupture. |
|
|
Term
| A female that is heterozygous for an X-linked recessive gene will eliminate the bad gene if it's a fatal mutant as in ____________________. |
|
Definition
| Ornithine transcarbamylase mutation |
|
|
Term
| ____________________ is an example of a mitochondrial inheritance mutation. |
|
Definition
| Leber hereditary optic neuropathy; may be ok thanks to heteroplasmy. |
|
|
Term
| Deletion of chromosome 15 can cause _____________ or _____________ depending on if the mutation was inherited from mother or father. |
|
Definition
| Prader-Willi (UVE ligase missing) or Angleman syndrome (ubiquitin ligase missing) |
|
|
Term
| _________ is when mutations is different genes at different loci cause similar/same disease. |
|
Definition
|
|
Term
| ___________ is an example of variable expressivity when varying mutations within the same gene cause different degrees of disease; due to ALLELIC VARIATION. |
|
Definition
Neurofibromatosis 1
Variable number of cafe au lait, skeletal malformations, and cardiac defects. |
|
|
Term
| ________ genes may alter the impact of a genetic mutation relative to someone else with the same mutation. |
|
Definition
|
|
Term
| Examples of allelic variation when mutations is the same gene can cause different diseases. |
|
Definition
| MEN2A (exon 10,11), MEN2B neuromas (exon 15,16), and familial medullary thyroid carcinoma (exon 10-15). |
|
|
Term
| Examples of trinucleotide repeat diseases |
|
Definition
| Huntington's disease, fragile X syndrome, and Kennedy disease. |
|
|
Term
| Examples of multifactorial inheritance diseases |
|
Definition
Cleft lip/palate, neural tube defects, diabetes, schizophrenia, and coronary heart disease.
There is some degree of familial aggregation. |
|
|
Term
| A chromosomal microdeletion condition that is characterized by supravalvular aortic stenosis, elfin facies, short stature, dental malformation, lacey iris pattern, infantile hypercalcemia, and happy disposition. |
|
Definition
|
|
Term
| Williams syndrome has a deletion at chromosome __ and patients are........ |
|
Definition
| 7q....retarded but with normal IQs (strengths in muscial and verbal areas); affects elastin gene (aortic stenosis) and LIM-kinase-1 gene (poor visuospatial development). |
|
|
Term
| A balanced translocation can have the features of a ________________ gene disorder. |
|
Definition
| Autosomal dominant single gene disorder; you'll be ok but your offspring may get double of one chromosome and none of the other. |
|
|
Term
| _____________ is characterized by a specific subset of balanced translocations which involve the acrocentric chromosomes fusing at the two short ends. |
|
Definition
| Robertsonian translocation |
|
|
Term
| An aneuploidy condition where there are three copies of chromosome 21; short neck, flat nasal bridge, Brushfield spots on the iris, incurving of the fifth finger. |
|
Definition
Down syndrome
One third of patients have congenital heart disease; premature senility similar to Alzheimer's; in 5% of people with the disease, there is another type of translocation other than chromosome 21. |
|
|
Term
| 45X chromosomal make-up; webbed neck, low posterior hairline, growth retardation, failure to develop secondary sex characteristics, high arched palate, and aortic/kidney malformations. |
|
Definition
|
|
Term
| Acute abscess arising within a periapical granuloma. |
|
Definition
|
|
Term
| Osteomyelitis is more common in (men/women) and (mandible/maxilla); hypovascularity of the area may be caused by ____________ or ______________. |
|
Definition
| Men.....mandible; Paget's disease or florid cemento-osseus dysplasia. |
|
|
Term
| Bone production at the apex of a tooth; usually lower first molar. |
|
Definition
| Focal sclerosing osteomyelitis (Condensing Osteitis); mild pain but otherwise asymptomatic; bone is vital, but tooth is dead :( |
|
|
Term
| In order for caries crystals to form, _______________ must be viable. |
|
Definition
| Odontoblastic processes; caries crystals is different than dentinal sclerosis. |
|
|
Term
| Chronic reparative dentin is more (organized/irregular). |
|
Definition
| Organized; the more irregular the dentin is, the more impermeable it will be. |
|
|
Term
| A condition when pulp gets completely covered by dentin; the tooth is non-vital and looks yellow/brown. |
|
Definition
|
|
Term
| Pulp is RAPIDLY invaded by VIRULET bacteria. |
|
Definition
|
|
Term
| Cellulitis can occur instead of an abscess when the infection is above or below this muscle. |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Chronic pulpitis will lead to a _______________. |
|
Definition
| Periapical granuloma (not a true granuloma); we see collagen, fibroblasts, and mast cells. |
|
|
Term
| Tooth decay where most of the pulp is exposed to the environment; chronic hyperplastic pulpitis as a protective mechanism. |
|
Definition
| Pulp polyp; tooth is still VITAL; give CaOH to relieve the hyperplasia. |
|
|
Term
| Bone appearance during acute osteomyelitis....... |
|
Definition
| Bone has no osteocytes; necrotic bone becomes sequestered; we should do minimal debridement unless necessary; do NOT surgically remove infected bone. |
|
|
Term
| During chronic osteomyelitis, we see......... |
|
Definition
| Scar tissue replacing bone; this lesion WILL STILL SPREAD; still see jagged resorption around bone; surgical intervention is mandatory and hyperbaric oxygen may be necessary. |
|
|
Term
| Teeth appear fused but tooth count is normal. |
|
Definition
|
|
Term
| Three conditions which cause the formation of pathologic tertiary dentin: |
|
Definition
1) attrition (bruxism)
2) abrasion (can also be caused by sucking on orange peels)
3) Erosion |
|
|
Term
|
Definition
|
|
Term
| Hypercementosis is common with ____________. |
|
Definition
|
|
Term
| Hypodontia can be caused by ___________ or ___________. |
|
Definition
| Ectodermal dysplasia (most common variant is X-linked) or hereditary oligodontia (everything else is normal but the teeth; can be caused by several genetic mutations). |
|
|
Term
| Hyperdontia can be caused by _____________ or ______________. |
|
Definition
| Cleidocranial dysplasia (patient also missing clavicles) or familial adenomatous polyposis (patients predisposed to cancer, etc.) |
|
|
Term
| AMELX, ENAM, MMP20, KLK4, WDR72, and FAM83H |
|
Definition
| Genes that can cause amelogenesis imperfecta; can be autosomal dominant, recessive, or X-linked; enamel is hypoplastic, hypomatured, and hypocalcified. |
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Term
| Type I dentinogenesis imperfecta is caused by _______ or _______ genes while Type II dentinogensis imperfecta is caused by the ______ gene. |
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Definition
| COL1A1 or COL1A2.........DSPP (only teeth affected). |
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Term
| Radiographic findings for dentinogenesis imperfecta. |
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Definition
| Pulpal obliteration in most cases (or else "ghost teeth"), cervical constriction, and canals either enlarged OR obliterated. |
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Term
| Defect in radicular dentin; "rootless" or "stumped" teeth; pulps obliterated, prone to infection; severely affects deciduous teeth. |
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Definition
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Term
| Defect in coronal dentin; DSPP mutations. |
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Definition
Type II dentin dysplasia
Identical to dentinogenesis imperfecta (just a specific genotype). |
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Term
| A metabolic bone disease that causes a deficiency in alkaline phosphatase; increased urinary phosphoethanolamine; absence or decrease in the amount of cementum creating enlarged pulps and spontaneous tooth exfoliation. |
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Definition
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Term
| Defects in these two genes can cause hypophosphatasia. |
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Definition
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Term
| Porphyria (inability to metabolize heme) can cause this in the oral cavity. |
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Definition
| Abnormal tooth color; the dentin is also soft. |
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Term
| An oral condition that causes "ghost teeth", thin enamel (no contrast between enamel and dentin), enlarged pulps, usually affects contiguous teeth, and would not exclusively occur in permanent teeth. |
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Definition
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Term
| Which immunoglobulin has no memory? |
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Definition
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Term
| ___________ and ___________ play a role in both the innate and adaptive immune systems. |
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Definition
| Neutrophils and macrophages |
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Term
| The order for most common immunoglobulins in serum is...... |
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Definition
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Term
| Ig__ is primarily involved in agglutination. |
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Definition
| IgA; IgG, IgD, and IgG can be the receptor on B-cells. |
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Term
| Classical pathway to make a C3 convertase........... |
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Definition
| Activated antibody (mannose binding lectin) that changes its Fc region and binds C1, C2, and C4. |
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Term
| Alternative pathway for C3 convertase...... |
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Definition
| Bacteria activates residual C3b which binds Factors P, B, and D. |
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Term
| Which two complement proteins are anaphylatoxins? |
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Definition
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Term
| Which two complement proteins are chemotactic factors? |
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Definition
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Term
| Which complement proteins are involved in virus neutralization? |
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Definition
| C1-C4 are bound by antibody-coated virus. |
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Term
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Definition
| Water enters a cell with the hydrophilic transmembrane channels created by complement-mediated cell lysis; this causes the cell to swell and burst. |
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Term
| Which two interleukins downregulate lymphatic activity? |
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Definition
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Term
| A CD4 T-cell can either differentiate into a _______ or _______. |
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Definition
| Memory T-cell or CD8 cytotoxic cell via cytokines. |
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Term
| Two of the cytokines produced by cytotoxic T-cells are....... |
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Definition
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Term
| Class I MHC binds........ |
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Definition
| Peptides derived from proteins synthesized in cells (i.e. viral protein). |
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Term
| Class II MHC binds....... |
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Definition
| Peptides from exogenous proteins that are first internalized and processed. |
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Term
| Natural killer cells do not have _____________ or express ___________. |
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Definition
| No antigen receptor nor do they express cell surface CD3; has an inhibitory self Class I MHC; can induce APOPTOSIS via direct contact or ADCC (tumor resistance); also called Large Granular Lymphocytes (LGLs); part of the INNATE IMMUNE SYSTEM! |
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Term
| __________ is a substance that enhances the immunogenicity of an antigen; polyclonal cell activators (PCA) are an example of these on bacteria or plants that NONSPECIFICALLY activate the immune system (both T and B cells). |
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Definition
Adjuvants
Mixed with vaccines to make antigens last longer; calcium phosphate, etc. |
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Term
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Definition
| Umbrella term for diseases associated with the production of IgE; can be due to both genetic and environmental factors. |
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Term
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Definition
| Term applied to those antibodies responsible for allergic responses; only IgE causes anaphylaxis. |
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Term
| CD__ is the part of the Fc receptor on IgE (and sometimes IgG) that allows it to attach to mast cells. |
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Definition
| CD23; the antibody is now "homocytotropic" |
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Term
| When IgE is crosslinked by an antigen, these mediators play a role..... |
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Definition
| Histamine (also stimulated by platelet activating factor), eosinophil chemotactic factor (ECF-A), neutral proteases (cleave complement), and heparin (a proteoglycan that serves to package other secondary mediators). |
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Term
| ________ is the most common form of allergic disease. |
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Definition
| Allergic rhinitis (can cause conjunctivitis as well); chronic rhinitis may cause serous otitis media as well. |
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Term
| ________ is a transient eruption of erythematous and/or edematous swelling of the dermis in response to Type I hypersensitivity. |
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Definition
Urticaria
Hereditary angioedema (affects face and lips) is NOT Type I hypersensitivity (C1 complement inhibition). |
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Term
| A manifestation of allergic gastroenteritis is....... |
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Definition
| Perioral erythema along with hives and vomiting. |
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Term
| Anaphylactic shock can be avoided by giving the patient __________. |
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Definition
| Cromolyn sodium (inhibits mast cell degranulation). |
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Term
| In Type II hypersensitivity, complement activation can cause __________ and ___________. |
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Definition
| Neutropenia and lymphopenia; C3b if complement is involved or ADCC by NK cells if complement activation is absent. |
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Term
| Haptens usually involve this type of cell. |
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Definition
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Term
| The warm type of hemolytic anemia is....... |
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Definition
| Extravascular hemolysis in the spleen mediated by IgG. |
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Term
| ________ is a passive anti-serum that attacks Rh antigen before mom can. |
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Definition
| Rhogam; jaundice in the mother is a sign of Erythroblastosis fetalis (Type I Hypersensitivity along with hyperacute allograft rejection) |
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Term
| Type III hypersensitivity reactions can cause necrosis either by....... |
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Definition
PMN release of lysozymes (via complement activation) or ischemia (via platelet and Hageman factor activation).
There can also be just vasodilatino and edema via kinin and complement activation. |
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Term
| Hepatitis B can cause a Type III hypersensitivity reaction called ______________. |
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Definition
| Polyarteritis nodosa (vasculitis of medium-sized vessels). |
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Term
| The best type of antigen to cause a Type III hypersensitivity reaction is...... |
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Definition
| A multivalent antigen that is in slight excess of antibodies and forms intermediate-sized complexed that can fix complement. |
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Term
| Ig__ and Ig__ are involved in Type III hypersensitivity because they can....... |
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Definition
| IgG or IgM because they can activate complement. |
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Term
| Most immune complexes require CD4 T-cells to induce class switching on B-cells; however, this is an exception...... |
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Definition
| ABO antigens on RBCs can induce the release of IgM by themselves! |
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Term
| _________ necrosis is seen in Type III hypersensitivity reactions. |
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Definition
| Fibrinoid necrosis; not true necrosis though; sign of an advanced stage of the disease. |
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Term
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Definition
| Local injection of antigen to which IgG antibodies have been made will result in vasculitis and possibly vessel occlusion. |
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Term
| ______________ is an example of a Type III hypersensitivity reaction. |
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Definition
| Hypersensitivity pneumonitis (caused by Micropolyspora faeni resulting in Farmer's lung, etc.). |
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Term
| Example of a microbial antigen causing a Type III hypersensitivity reaction. |
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Definition
| Syphilis resulting in subacute bacterial endocarditis; periodontal disease is also thought to be able to form immune complexes from plaque bacteria. |
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Term
| DTH reactions are directly dependent upon........ |
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Definition
| The development of an altered state of macrophage activity whose ultimate goal is the accumulation of nonspecific cytotoxic macrophage effector cells (increased size and enzymes of the Embden-Meyerhoff pathway and HMP shunt). |
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Term
| In order for macrophages to become activated in DTH reactions, they need these three lymphokines.... |
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Definition
1) IFN-gamma
2) IL-4
3) GM-CSF |
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Term
| In contact dermatits, we see........ |
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Definition
| Intercellular edema (spongiosis) and vascular cuffing (vessel not destroyed though). |
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Term
| The main types of T-cells present in DTH reactions are...... |
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Definition
| CD4Th1 and CD8; usually no need for antibody production via CD4Th2 cells. |
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Term
| Bacillic Calmetta Geurin (BCG) |
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Definition
| An attenuated strain of TB for vaccination. |
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Term
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Definition
| An early TB lesion draining to the hilar lymph nodes (this is primary TB unlike miliary TB where there are granulomas all over the body). |
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Term
| "Activation-induced death" |
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Definition
| Self antigen is presented to a CD4 cell in the context of MHC Class I; CD4 cell then undergoes apoptosis, thus killing off that clone. |
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Term
| In ___________, intrinsic factor is the antigen which causes megaloblastic anemia and reduced hematocrit. |
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Definition
Pernicious anemia
Other hematopoietic problems arise from large megakaryocytes. |
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Term
| In ___________, the antigen is a membrane glycoprotein IIb/IIIa complex. |
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Definition
Autoimmune thrombocytopenia
IgG and IgM cause classic low platelet manifestations. |
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Term
| The destructive agent in Type I diabetes. |
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Definition
| T-cells (auto-antibodies are not destructive); there is a genetic susceptibility associated with specific alleles of Class II MHC. |
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Term
| Some of the clinical manifestations in diabetics include....... |
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Definition
| Bacterial and fungal infections causing pyelonephritis from chronic renal failure; ketoacidosis potentiates the growth of Mucor in the nasopharnygeal region; periodontal disease is more aggressive due to the vascular pathology. |
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Term
| Three mechanisms that account for the loss of ACh receptors in myasthenia gravis: |
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Definition
1) Crosslinking of receptors with their removal by internalization
2) Destruction of receptors by the action of complement
3) Blocking of the receptors
Can cause ptosis |
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Term
| In _____________, the antigen is thyroglobulin (thyroid peroxidase) causing high TSH levels and weight gain; also fatique and myxedema. |
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Definition
Hashhimoto's Thyroiditis
Several types of antibodies including antimicrosomal and antithyroglobulin antibodies. |
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Term
| Patients with this HLA gene have a predisposition to Hashhimoto's Thyroiditis, and patient's with HLA-___ are susceptible to Graves disease. |
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Definition
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Term
| In ___________, the antigen is the TSH receptor which activates adenylate cyclase pathways; causes weight loss and low TSH levels. |
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Definition
Graves disease
The antibodies are called thyroid growth-stimulating immunoglobulins (TGIs) |
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Term
| Clinical manifestations of Graves disease..... |
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Definition
Exophthalmos and infiltrative dermopathy on the dorsum of the legs or feet (accumulation of glycosaminoglycans with inflammatory cells; no inflammatory cells in the thyroid (unlike Hashhitmoto)....just too many follicular cells with too little colloid.
Orally, premature exfoliation of deciduous teeth and osteoporosis of the jaws. |
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Term
| In ____________, the antigen is a cross reacting antibody (antigenic mimicry) that occurred from fighting beta-hemolytic streptococci; we see carditis due to Type II response and cardiac dilation with possible insufficiency of the mitral valve. |
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Definition
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Term
| In rheumatic fever, this is seen histologically and is pathognomonic. |
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Definition
Aschoff bodies; foci of collagen necrosis with firbin deposition and surrounded by lymphocytes, macrophages, and Aschoff cells; sometimes the Aschoff cells form multinucleated giant cells.
Aschoff bodies mainly affect heart valves and are replaced by a fibrous scar.
Anitschkow cells are also seen (they make up the Aschoff body). |
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Term
| In __________, the antigen is a cytoskeletal protein (alpha-fodrin); due to B-cell dysfunction, hypergammaglobulinemia, rheumatoid factor in the serum, antinuclear antibodies, keratoconjunctivitis, and xerostomia. |
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Definition
Sjogren syndrome
A lip biopsy is REQUIRED to show T-CELL infiltrate in the minor salivary glands. |
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Term
| Primary Sjogren Syndrome vs. Secondary Sjogren Syndrome |
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Definition
| Primary is when the sicca complex (dry eyes and dry mouth) occurs in conjunction with a connective tissue disease, and Secondary is when the sicca complex occurs by itself. |
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Term
| In _____________, the antigen is alpha-3 chain of Type IV collagen in the basement membrane; mainly affects lung and kidney (hemorrhagic). |
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Definition
Goodpasture disease
In connective tissue disease, the antigen is ALWAYS soluble! |
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Term
| In multiple sclerosis, how do the "plaques" vary with age? |
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Definition
Initially, they are slight pink and swollen; later, they become gray, sunken, and opalescent.
Most of the damage is done by T-cells and macrophages; earliest loss of myelin is seen around small veins and venules. |
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Term
| In SLE, antibodies to __________ and __________ are virtually diagnostic of the disease. |
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Definition
Double-stranded DNA and the Sm(Smith) antigen.
Antigens are both soluble and tissue-bound (antibodies against platelets and blood cells)! |
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Term
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Definition
Nuclei of damaged cells react with antinuclear antibodies, lose their chromatin pattern, and become homogenous.
LE cells are only seen in vitro. |
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Term
| This clinical manifestions is considered highly specific for SLE. |
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Definition
| Granular deposits in uninvolved skin. |
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Term
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Definition
1) Kidney- glomerulonephritis
2) Serosal membranes- pericarditis and pleuritis; foci of fibrinoid necrosis
3) Cardiovascular system- Libman-Sacks endocarditis, tachycardia, and ECG abnormalities.
4) Oral lesions with similar histology to skin lesions |
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Term
| In ___________, the antigen is IgG that is abnormally glycosylated; may resemble SLE and involve other organs. |
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Definition
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Term
| This finding is pathognomonic for rheumatoid arthritis. |
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Definition
Rheumatoid subcutaneous nodule; partially moveable, nontender oval or rounded nodules.
They appear on the extensor surfaces of joints; central focus of fibrinoid necrosis surrounded by macrophages which in turn is rimmed by granulation tissue. |
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Term
| Skin manifestations of lichen planus..... |
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Definition
Purple, pruritic, and polygonal papules that are limited to the flexor surfaces of the extremities.
Not an autoimmune disease.....Type IV hypersensitivity. |
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Term
| In lichen planus, the basal cell layer exhibits __________ and the epithelial cells form ___________. |
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Definition
| Hydropic degeneration.......colloid bodies. |
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Term
| ______________ is a condition which looks similar to lichen planus, but the lymphocyte infiltrate is not as dense; can be caused by medications; we also see PERIVASCULITIS. |
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Definition
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Term
| ________________ is an autoimmune disease that looks like lichen planus but does not respond well to topical corticosteroids. |
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Definition
| Chronic ulcerative stomatitis |
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Term
| BPAg1, BPAg2, and epiligrin are known antigens for ____________. |
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Definition
| BMMP; diagnosis often made by histology alone; ophthalmology consult is mandatory! |
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Term
| Bullous pemphigoid differs from BMMP in that....... |
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Definition
| Skin lesions are almost always present, heals without scarring, has different epitopes on antigens BPAg1 and BPAg2, and both DIF and IIF can be used. |
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Term
| In ___________, the basal cells look like tombstones lined up in a row. |
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Definition
| Pemphigus vulgaris; mortality is usually due to complications from treatment. |
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Term
| The lymphocyte responsible for recurrent aphthous stomatitis is.......... |
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Definition
| CD8 T-cells; there is a decreased percentage of CD4 T-cells. |
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Term
| Which form of aphthous stomatitis is the most severe? |
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Definition
Major form (Sutton's disease); ulcerations tend to heal with scarring.
Topical corticosteroids may help. |
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Term
| The diagnosis for Behcet's syndrome...... |
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Definition
6 or more aphthae that have recurred at least 3 times in 1 year AND at least two of the following:
1) ocular lesions
2) skin lesions
3) positive pathergy test
Aphthous ulcers usually precedes other sites of disease involvement. |
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Term
| Secondary herpes (like herpes labialis) differs from primary herpes in the fact that............. |
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Definition
| Systemic signs and symptoms are usually not seen. |
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Term
| The pathognomonic lesion for erythema multiforme minor....... |
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Definition
| Target-like or iris lesion (not always present though); lips are often covered with blood-filled blisters that may have a fibrinous pseudomembrane. |
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Term
| Erythema multiforme major (Steven-Johnson syndrome) differs from EM minor in the fact that....... |
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Definition
| It is usually triggered by a drug, and ocular and genital mucosa are often involved; severe involvement of the eye may lead to scarring. |
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Term
| Toxic epidermal necrolysis (Lyell's disease) differs from the other forms of EM in the fact that............. |
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Definition
| It occurs in older people and affects WOMEN MORE THAN MEN; potentially life-threatening diffuse sloughing of the skin and mucous membranes. |
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Term
| Differential diagnosis for desquamative gingivitis (painful loss of epithelium covering gingiva). |
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Definition
1) Erosive lichen planus/lichenoid mucositis
2) Cicatricial pemphigoid
3) Pemphigus vulgaris |
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|
Term
| Complement deficiencies often lead to infections by __________ and __________. |
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Definition
| N. meningitidis and N. gonorrhea |
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Term
| Failure of pre-B cells to differentiate into mature B-cells; mutation in tyrosine kinase; rearrangement of immunoglobulin heavy chain genes; does not become apparent until 6 months of age. |
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Definition
| X-linked agammaglobulinemia; patient is susceptible to some viruses such as echovirus and enterovirus infections as well as Pneumocytis carinii and Giardia lambdia. |
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Term
| Inability of B-cells to differentiate into plasma cells; may be due to T-cell, B-cell, or suppressor T-cell deficit; presents clinically as a respiratory tract infection. |
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Definition
| Common variable immune deficiency (acquired or late onset agammaglobulinemia) |
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Term
| T-cell deficiency resulting from an intrauterine accident; patient is also susceptible to intracellular bacteria due to lack of cytokines required by macrophages. |
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Definition
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|
Term
| Clinical manifestations of Di-Georges syndrome |
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Definition
| Aortic arch defects, low calcium due to parathyroid hypoplasia (hypocalcemic tetany), and midline developmental abnormalities. |
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|
Term
| Failure in heavy chain class switching; eyes are far apart. |
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Definition
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Term
| X-linked deficiency in cytokine receptors causing deficiencies in both T-cell and B-cells (B-cells sometimes present but not functional); thymus is embryonic (pathognomonic for this disease). |
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Definition
Swiss type SCID; three types:
1) SCID with adenosine deaminase deficiency
2) SCID with purine nucleoside phosphorylase deficiency
3) SCID with MHC Class II deficiency
*most patients have deficiencies in enzymes linked to purine metabolism. |
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Term
| The neoplastic disease most often present in AIDS patients is ____________. |
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Definition
| Kaposi's sarcoma (tumor of the vascular epithelium - HSV-8) |
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Term
| HLA-D Class II gene differs from HLA-A, B, and C Class I in the fact that...... |
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Definition
It is lymphocyte defined (instead of serologically defined) and its receptor has no beta-microglobulin.
The serologically defined antigens have antibody-mediated cytotoxicity and agglutination while lymphocyte defined antigens have a mixed lymphocyte reaction. |
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Term
| This type of transplant rejection mainly involves Class I MHC and attacks endothelial cells and forms a fibrous thrombus. |
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Definition
| Hyperacute/accelerated rejection |
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|
Term
| This type of transplant rejection involves both Class I and Class II MHC; CD8 T-cells attack endothelium causing hemorrhage; controlled by immunotherapy. |
|
Definition
|
|
Term
| Graft versus host reactions involve which two types of cells and target which four organs? |
|
Definition
T-cells and NK cells; target:
1) Lung- interstitial pneumonia
2) Skin- loss of pigmentation in blacks
3) GI tract- bloody diarrhea
4) Liver- destruction of bile ducts leading to jaundice
GvH reactions can also result in oral ulcers. |
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