**opat - Exam 3 - Lecture 1 - Vb Lesions

Front 1

What are 3 diseaes that mimic VB lesions?

Back 1

Oral herpes
Apthous ulcer
Lichen planus

Front 2

Describe in 3 steps the process of an oral herpes ulcer

Back 2

prodrome itch---> vesicle--->ulcer

Front 3

Which of these (the prodrome itch, vesicle or ulcer) is the infectious part of a herpes lesion?

Back 3

vesicle

Front 4

Where do herpes ulcers occur?

Back 4

angle of mouth
hands
if oral, only on bound mucosa, unless primary then anywhere in mouth

Front 5

what is the oral condition caused by a primary herpes infection?

Back 5

primary gingivostomatitis

Front 6

Where does the herpes virus reside in oral cases?

Back 6

trigeminal ganglion

Front 7

What is the unique histological cell, that is characteristic of oral herpes?

Back 7

TZANK cell

Front 8

What is the Tx for oral herpes

Back 8

acyclovir/valacyclovir

Front 9

What are the 3 types of aphthous ulcers?

Back 9

minor - <.5cm
major >.5cm
herpetiform - 10-100 count

Front 10

How do you distinguish a minor vs a major aphthous ulcer? (5 things)

Back 10

- size (less or greater than .5cm)
- shape - minor round, major ragged
- duration (7-10 days for a minor, 6 weeks for major)
- Scarring (only major does)
- disease assoc w/ (crohn's for minor, suttons for major)

Front 11

What is the Tx for aphthous ulcers?

Back 11

topical steroids
magic mouthwash (=benadryl/maalox/kaopectaate)

Front 12

what is magic mouthwash and what does it treat?

Back 12

benadryl + maalox + kaopectate
aphthous ulcers

Front 13

What are the differences between major/minor aphthous ulcers and herpetiform a. u.'s? (2)

Back 13

wher they occur
min/major only on non-bound/non-keratinized
herpetiform - occurs anywhere, non bound or bound mucosa

Also - # - 10-100 for herpetiform, <10 for minor/major

Front 14

What are differences between herpes and herpetiform aphthous ulcers? (3)

Back 14

herpes starts as a vesicle, h.a.u as an ulcer
viral culture would be different
only herpes has a tzank cell

Front 15

What oral lesion is associated with crohn's disease?

Back 15

minor aphthous ulcer

Front 16

what oral lesion is asociated w/ sutton's disease?

Back 16

major aphthous ulcer

Front 17

Which aphthous ulcers heal w/ scars?

Back 17

major only
(minor and herpetiform do not)

Front 18

What disease that mimics VB lesions is caused by autoimmune/tcell dysfunction?

Back 18

lichen planus

Front 19

What lesions produces a charactersitc "wickham's striae" in the mouth?

Back 19

lichen planus

Front 20

Histology of Lichen Planus.
Seen to have __a__destruction. It also show's a thinned __b__layer, with specific cells called __c__, which are__d___ within the epithelium. There is a significant __e__deposition, and it immunofluouresces @ the __f__because of the _g__cells, which can be detected via__h__.
However, if it is the _i___subtype, the difference in histology is__j__

Back 20

a - basal cell
b - epithelial
c - civatte bodies,
d - apoptotic keratinocytes
e - fibrinogen
f - basement membrane
g - inflammatory
h - direct, NOT indirect IF
i - erosive
j - subepithelial SPLIT

Front 21

What are civatte bodies? Where are they seen?

Back 21

apoptotic keratinocytes, seen in LICHEN PLANUS

Front 22

Patients of LIchen planus...
age?
gender?
Where are the skin lesions?
where are oral lesions?
any special names for oral lesions (there are 2)

Back 22

middle age
m=f
skin lesions on flexor surface
oral on BM>ventral tongue>gingiva
special names for oral: wickham's striae, desquamative gingivitis

Front 23

Lichen Planus of the gingiva is called

Back 23

desquamative gingivitis

Front 24

What is the condition that looks like lichen planus, but is caused by drug rxn?

Back 24

lichenoid mucositis

Front 25

What is the treatment plan for lichen planus? (4 moves)

Back 25

ONLY if it has pain (erosive kind)
start w/ topical steroids
move to superpotent
move to systemic
move to immunomodulators (anti-malarials etc.)

Front 26

3 Intraepith VB lesions

Back 26

pemphigus
benign familial pemphigus
Darier's disease

Front 27

What are the 2 types of pemphigus relevant to dentists?

Back 27

vulgaris and vegetans

Front 28

what is the difference between pemphigus vulgaris and pemphigus vegetans?

Back 28

vegetans has abscesses/eosinophils/PUS

Front 29

Why is pemphigus able to be detected through immunofluoresence?

Back 29

it has circulating IgG

Front 30

what is the Antigen of Pemphigus?

Back 30

desmoglian 3

Front 31

Desmoglian 3 is the antigen of what lesion?

Back 31

pemphigus

Front 32

What types of lesions have nikolsky positive?

Back 32

intapeith- NOT subepith
(so pemphigus, benign familial pemph, darier's disease)

Front 33

What is the treatment for pemphigus (2 options)

Back 33

steroids, or immunosuprresants if needed

Front 34

Describe the process of pemphigus doing what it does (4 steps)

Back 34

1. ab is produced in bone marrow
2. the ab binds an ag (desmoglian 3)
this binding activates
3. compliment, and then protease, which causes...
4. acantholysis - epith cells to spllit from one-another

Front 35

T orF
in 60% of pemphigus patients, the 1st sign is seen on the skin

Back 35

F
60% 1st is oral

Front 36

What conditions have desquamative gingivitis?

Back 36

LP
pemphigus

Front 37

Since pemphigus is a condition in which epithlial cells split form one another, what unique histological feature can you see?

Back 37

tzank cells

Front 38

how do you distinguish Pemphigus from pemphigoid based on IF? (2 things)

Back 38

pemphigoid shows IF @ the basement membrne, pemphigus w/in epithelium
Pemphigus' ag is desmoglian 3
pemphigoid is laminin 5

Front 39

laminin 5 is the identifying Ag of...

Back 39

pemphigoid

Front 40

desmoglian 3 is the identifying ag of....

Back 40

pemphigus

Front 41

Desribe paraneoplastic pemphigus in relation to "malignancy"

Back 41

it itself is not malignant, hwoever it is 2ndary to a malignant condition

Front 42

What is paraneoplastic pemphigus most often seen with (what othe condition)

Back 42

lymphoma

Front 43

lymphoma is often associated with what VB lesion?

Back 43

paraneoplastic pemphigus

Front 44

What is the only VB lesion htat effects both epithelium and the basement membrane?

Back 44

paraneoplastic pemphigus

Front 45

In Paraneoplastic pemphigus, the lesions are 2ndary to __a__, such as _b__, the most common condition. Patients will experience__c__. Histologiclaly, the ab's seen are similar to _d___, and can be seen__e__. This can be detected by__f__IF.

Back 45

a - malignancy
b - lymphoma
c - SEVERE pain
d - pemphigus
e - in epith, and @ BM
f - direct or indriect

Front 46

Darier's disease is caused by a defective _____gene.

Back 46

ATP2a2

Front 47

A defective ATP2a2 gene causes

Back 47

darier's disease

Front 48

inheritance of darier's disease is

Back 48

auto dominant

Front 49

Darier's disease lesions are small, but are known to __a__, often seen in __b__patients. The main issue for these patients is__c_, and you can also see_d___ in them.

Back 49

a - coalesce
b - 2-20y/o
c - 2ndary infection
d - nail splits

Front 50

Dairer's disease main issue is that there is excess _a___, causing __b___. These (b) can be seen __c___(where), and the cells that produce them are called___d____. Because of where these (b) end up, they cause __e___as well, leaving __f__to form

Back 50

a - keratin
b - keratin plugs
c - in vertical intraepith clefts
d - corps rounds and grains
e - acantholysis
f - tzank cells

Front 51

corps rounds and grains describes what, of what condition?

Back 51

describes the benign dyskeratotic cells in dariers' diseae

Front 52

2 unique cells seen in dariers disease

Back 52

tzank cells
corps rounds and grains

Front 53

Looking at histology, if there is a subepith split and basal cells present, the condition is....
If there are NO basal cells, the condition is....

Back 53

1 - if basal cells = pemphigoid
2 - if no, erosive lichen planus

Front 54

Difference between erosive lichen planus and pemphigoid?

Back 54

basal cells are present only in pemphigoid

Front 55

Bullous pemphigoid is (generalized/localized) and often seen on the...(parts of body)

Back 55

generalized
lower abdomen/limbds

Front 56

Lesions of bullous pemphigoid are__a__, which are nikolsky__b__, and__c__scar. it is 2x as____d___(rare/common) as pemphigus. It's auto-ag's are___e___(3). The split is___f___, and can be seen @___g___, through__h__, by the fact that it has circulating___i__.

Back 56

a - blisters
b - negative
c - do not
d - common
e - BP 230,180 and laminin 5
f - subepithelial
g - lamina lucida level
i - IgG, C3

Front 57

what are the antigens for pemphigoid?

Back 57

BP 230, 180, lamini 5

Front 58

T or F
Acantholysis is seen in pemphigoid

Back 58

F - it can't be seen in subepithelial stuff

Front 59

Which pemphigoid(s) is more common in females?

Back 59

cicatricial, gestational

Front 60

Which pemphigoid has eye problems?

Back 60

cicatricial

Front 61

3 eye problems of cicatricial pemphigoid, what are they?
a - symblepharon
b - entropion
c - trichiasis

Back 61

a - scarring of canthus
b - inverted eyelid
c - trauma to cornea

Front 62

It is more common to see (bullae/ulcer) in cicatricial pemphigoid

Back 62

ulcer

Front 63

An oral sign of cicatricial pemphigoid is

Back 63

desquamative gingivitis

Front 64

What does this describe
Basal layer still intact
IgG and C3 IF @ lamina lucida of basement membrane
it is D IF +, IIF -
Ags are BP230, 180, Laminin 5 and type 7 collagen

Back 64

cicatricial pemphigoid

Front 65

cicatricial pemphigoid is seen histologically @ the __a__, sepcifically the level of __b__ with basal cell__c___. . It IF's there through __d__, and this is due to the fact htat it has circulating __e__. It's ag's are__f___.

Back 65

a- basement membrane
b- lamina lucida
c- preservation
d- DIRECT ONLY
e- IgG and C3
f- BP230, 180, Laminin 5, type 7 collagen

Front 66

What does this describe
Basal layer still intact
IgG and C3 IF @ lamina lucida of basement membrane
it is D IF +, IIF +
Ags are BP230, 180, Laminin 5

Back 66

bullous pemphigoid

Front 67

What are the antigens for cicatricial pemphigoid?

Back 67

BP 230
BP 180
laminin 5
type 7 collagen

Front 68

Where is desquamative gingivitis seen? (3)

Back 68

LP
pemphigus
pemphigoid

Front 69

When is Gestational Pemphigoid seen?

Back 69

@ 2nd trimester of pregnancy
until birth, then goes away unless pt takes OC then it could come bcak

Front 70

Gestational pemphigoid is also known as

Back 70

herpes gestationis

Front 71

herpes gestationis is also known as

Back 71

gestational pemphigoid

Front 72

ALL pemphigoids are seen @ level of

Back 72

lamina lucida of subepith BM

Front 73

Where is the area of blisters for gestational pemphigoid?

Back 73

around the belly button - uticarial/umbiliucs area

Front 74

what VB lesion condition is often seen around the umbilical area?

Back 74

herpes gestationis aka gestational pemphigoid

Front 75

Linear IgA Bullous Dermatosis can be distinguished from other _____, in that it has_____.

Back 75

pemphigoids
IgA

Front 76

3 types of Linear IgA bullous dermatosis

Back 76

Childhood, adult, vancomycin induced

Front 77

What VB lesion is identified by IF of IgA?

Back 77

Linear IgA bullous dermatosis

Front 78

What is unique about the IF of Linear IgA bullous dermatosis

Back 78

it has IgA IF
and ONLY Direct

Front 79

How do you distinguish bulloous pemphioid from cicatricial pemphigoid? (5 things)

Back 79

1 bullous has no scarring, cicatricial scars
2 cicatricial more common in F, bullous m=f
3 cicatricial has ulcers, bullous you see bullae/blister
4 cicatricial has eye problems, bullous doesn't
5 bullous is DIF or IIF, cicatricial is DIF only

Front 80

Dermatitis herpetiform is associated with____disease

Back 80

Celiac's disease

Front 81

celiac's disease is assoc with what VB condition?

Back 81

dermatitis herpetiform

Front 82

Dermatitis herpetiform is seen in ____patients, usually ___(M/F)__ with periods of _____.

Back 82

young adult
M
remission

Front 83

The lesions of this VB condition are often seen on EXTENSOR surfaces w/ a symmetric distribution and are itchy

Back 83

dermatitis herpetiform

Front 84

This VB condition can only be diagnosed w/ direct IF of IgA @ tips of dermal papilla between rete pegs

Back 84

Dermatitis herpetiform

Front 85

how do you diagnose dermatitis herpetiform (histological)

Back 85

DIF (only) of IgA @ tips of dermal papilla, between rete pegs

Front 86

describe dermatitis herpetiform lesions

Back 86

itchy, red on extensor surfaces, are symmetrical

Front 87

What VB lesion condition sees a Basal cell AND basement membrane destruction (2)

Back 87

Epidermolysis Bullosa Dystrophica
paraneoplasic pemphigus

Front 88

What are the 2 types of epidermolysis bullosa dystrophica?

Back 88

Acquired - thru drugs
Genetic - dystrophica type, shows in neonatal - AD or AR

Front 89

What are the 2 types of inheritance of a gentic epirdermolysis bullosa dystrophica?

Back 89

AD or AR, AR is way worse

Front 90

What condition is described to have blistering/scarring with minor trauma?

Back 90

epidermolysis bullosa dystrophica

Front 91

"mitten hands" are common to

Back 91

epidermolysis bullosa dystrophica

Front 92

Hypoplastic teeth, constriction of oral cavity due to scarring is common to

Back 92

epidermolysis bullosa dystrophica

Front 93

What VB condition has a malignant potential?

Back 93

epidermolysis bullosa dystrophica

Front 94

in epirdermolysiis bullosa dystrophica, the mutation that can often lead to a malignancy is in what gene?

Back 94

type 7 collagen

Front 95

2 problems that are behind epidermolysis bullosa dystrophica

Back 95

fibril anchroing defect
deranged GAG metabolism

Front 96

fibril anchroing defect
deranged GAG metabolism

describes what?

Back 96

epidermolysis bullosa dystrophica

Front 97

What VB condition has "targetoid" lesions?

Back 97

erythema multiform

Front 98

describe erythema multiforme lesions?

Back 98

targetoid, symmetical

Front 99

3 forms of erythema multiforme, which is worse

Back 99

eryth multiforme - mild
toxic epidermal necrolysis - most severe
stevens johnson - moderate

Front 100

What are the casues of erythema multiforme? What type of condition is it?

Back 100

HYPERSENSITIVYT
drugs is major
herpes/mycoplasm is minor cause
could be idiopathic

Front 101

What condition is this? here are the causes
Drugs, Herpes, Mycoplasm or idiopathic

Back 101

erythema multiforme

Front 102

hwat tyupe of hypersensitivty reaction is erythema multiforme?

Back 102

humoral OR cellmediated

Front 103

Lupus erythematous comes in 3 types...which is worse?

Back 103

systemic (acute) vs subacute, and discoid (chronic)

Front 104

Lupus erythematous inovoves destruction of ____, which is its similarity to ____.

Back 104

basal cells
lichen planus

Front 105

What causes the basal cell destruction in Lupus erythematous?

Back 105

deposits of auto antibodies

Front 106

What are the differences between Lupus and Lichen planus? (

Back 106

ANA + for lupus
LE+ for lupus
Inflammatory cells are PERIVASCULAR for lupus
Shaggy band @ bm for lupus

Front 107

what are 2 serious complications of Lupus?

Back 107

kidney failure due to glomerulonephritis
libman sachs

Front 108

what VB condition may require abx prophylaxis?

Back 108

lupus because of libman sachs endocarditis

Front 109

libman sachs endocarditis is seen in what?

Back 109

lupus erythematous

Front 110

lupus erythematous patients can often die of this complication

Back 110

kidney failure

Front 111

wihch lupus erythematous type has scarring?

Back 111

the discoid (chronic)