Oral Pathology For the Dental Hygienist 6th Edition by Olga A. C. Ibsen – Test Bank
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Sample Test
Chapter 03: Immunity and Immunologic Oral Lesions
Test Bank
MULTIPLE CHOICE
1. The
breakdown of cellular adhesion between epithelial cells is called:
2. cell-mediated
immunity.
3. acantholysis.
4. Nikolsky
sign.
5. anaphylaxis.
ANS: B
Feedback
A
Cell-mediated immunity is immunity in which the predominant role is played by
T-lymphocytes.
B
Correct! Acantholysis is the dissolution of the intracellular bridges of the
prickle cell layer of epithelium.
C
Nikolsky sign occurs when the superficial epithelium separates easily from the
basal layer on exertion of firm, sliding, manual pressure.
D
Anaphylaxis is a severe type of systemic hypersensitivity reaction.
REF: Pemphigus Vulgaris,
page 100 OBJ: 1
2. Which
of the following is a protein molecule that is produced by plasma cells and is
also called an immunoglobulin?
3. An
autoimmune disease
4. A
natural killer cell
5. Rheumatoid
factor
6. An
antibody
ANS: D
Feedback
A
An autoimmune disease is a disease characterized by tissue injury caused by a
humoral or cell-mediated response against constituents of the body’s own
tissues.
B
A natural killer cell is a lymphocyte that is part of the body’s innate
immunity.
C
Rheumatoid factor is a protein, immunoglobulin M (IgM), found in serum and
detected in laboratory tests. It is associated with rheumatoid arthritis and
other autoimmune diseases.
D
Correct! An antibody is a protein molecule, also called an immunoglobulin, that
is produced by plasma cells and reacts with a specific antigen.
REF: Vocabulary, page 79 |
B-cell Lymphocyte, page
81
OBJ: 1
3. Which
lymphocyte matures without passing through the thymus and later can develop
into a plasma cell that produces antibodies?
4. T-lymphocyte
5. B-lymphocyte
6. Macrophage
7. LE
cell
ANS: B
Feedback
A
The T-lymphocyte matures in the thymus before migrating to tissues.
B
Correct! The B-lymphocyte matures without passing through the thymus and later
can develop into a plasma cell that produces antibodies.
C
A macrophage is a large tissue-bound mononuclear phagocyte derived from
monocytes circulating in the blood.
D
The LE cell is an atypical mature neutrophil characteristic of lupus
erythematosus and other autoimmune diseases.
REF: Vocabulary, page 79 |
B-cell Lymphocyte, page
81
OBJ: 3
4. In
which type of immune response do B-lymphocytes and antibodies play the
predominant role?
5. Cell-mediated
immunity
6. Immune
complex
7. Humoral
immunity
8. Passive
immunity
ANS: C
Feedback
A
In cell-mediated immunity, the T-lymphocyte plays the predominant role.
B
The immune complex is a combination of antigen and antibody.
C
Correct! In humoral immunity the B-lymphocytes and antibodies play the
predominant role.
D
Passive immunity occurs when antibodies produced by another person are used to
protect an individual from an infectious disease.
REF: Major Divisions of the
Immune Response, page 83
OBJ: 2
5. Which
one of the following is not a specific component of immunity?
6. A
humoral response
7. A
cell-mediated response
8. Memory
9. Pavementing
ANS: D
Feedback
A
Humoral immunity involves the production of antibodies. The B-lymphocyte is the
predominant cell.
B
Cell-mediated immunity involves the T-lymphocyte.
C
Memory is an important function of the immune system. Certain lymphocytes
retain the memory of an antigen after an initial encounter, allowing for faster
immune responses.
D
Correct! Pavementing is the adherence of white blood cells to the walls of a
blood vessel during an inflammatory response.
REF: Major Divisions of the
Immune Response; Memory and Immunity, pages 83-84
OBJ: 6
6. An
example of natural passive immunity would occur when:
7. antibodies
from a mother pass through the placenta to the developing fetus.
8. a
microorganism causes a disease.
9. a
person receives a vaccination.
10. a
person is immunized.
ANS: A
Feedback
A
Correct! Natural passive immunity occurs when antibodies from a mother pass
through the placenta to the developing fetus.
B
Active immunity occurs naturally when a microorganism causes a disease.
C
Active acquired immunity occurs as a result of vaccination.
D
After vaccination, the immune system produces a stronger response and prevents
the development of the disease. This production of acquired immunity is called
immunization.
REF: Types of Immunity, page
84
OBJ: 7
7. Which
one of the following is an example of type I hypersensitivity?
8. Immune
complexes formed between microorganisms and antibody in the circulating blood
9. Asthma
10. Autoimmune
hemolytic anemia
11. Serum
sickness
ANS: B
Feedback
A
In type III hypersensitivity, immune complexes are formed between
microorganisms and antibody in the circulating blood.
B
Correct! Asthma is an example of type I hypersensitivity.
C
Autoimmune hemolytic anemia is a type II hypersensitivity reaction.
D
Serum sickness is a classic example of a type III hypersensitivity reaction.
REF: Type I
Hypersensitivity, page
85
OBJ: 8
8. Which
one of the following routes of drug administration can cause the most
significant hypersensitivity reaction?
9. Topical
10. Patch
11. Parenteral
12. Oral
ANS: C
Feedback
A
It takes more time for topically applied drugs to enter the bloodstream
compared with parenterally applied (injected) drugs.
B
It takes more time for a drug to enter the bloodstream via a patch compared
with parenteral administration.
C
Correct! When the reaction occurs after parenteral administration (injection),
it may be more severe because the allergen can be carried quickly to many parts
of the body through the bloodstream.
D
It takes more time for oral medications to enter the bloodstream than
parenterally applied drugs.
REF: Hypersensitivity to
Drugs, pages 85-86
OBJ: 8
9. Which
of the following is a condition that involves a deficiency in number, function,
or interrelationships of the involved white blood cells and their products?
10. Autoimmune
disease
11. Leukocytosis
12. Immunodeficiency
13. Anaphylaxis
ANS: C
Feedback
A
Autoimmune disease is characterized by tissue injury caused by a humoral or
cell-mediated immune response against constituents of the body’s own tissues.
B
Leukocytosis is an increase in the circulating white blood cells. It is a
systemic sign of an inflammatory response.
C
Correct! Immunodeficiency is a type of immunopathologic condition that involves
a deficiency in number, function, or interrelationships of the involved white
blood cells and their products.
D
Anaphylaxis is a severe type of hypersensitivity reaction.
REF: Immunodeficiency, page
86
OBJ: 8
10. What
is the most common precipitating factor in the development of aphthous ulcers?
11. Allergy
12. Trauma
13. Systemic
disease
14. Citrus
foods
ANS: B
Feedback
A
Allergies do not cause aphthous ulcers.
B
Correct! Trauma is the most common precipitating factor in the development of
aphthous ulcers.
C
Aphthous ulcers do occur in association with certain systemic diseases, but
they are not the most common precipitating factor.
D
Citrus foods can trigger episodes of aphthous ulcers, but they are not the most
common precipitating factor.
REF: Aphthous Ulcers,
Recurrent Aphthous Ulcers, page 86
OBJ: 11
11. Certain
recurrent ulcers appear on movable mucosa. They are discrete, round-to-oval
ulcers that are 3 to 5 mm in diameter and exhibit a yellowish-white fibrin
center surrounded by an erythematous halo. They are called:
12. major
aphthous ulcers.
13. Sutton
disease.
14. herpetiform
aphthous ulcers.
15. minor
aphthous ulcers.
ANS: D
Feedback
A
Major aphthous ulcers are deeper in the tissue, are larger (5 to 10 mm),
take much longer to heal, and often heal with scarring.
B
Sutton disease is the same as major aphthous ulcers.
C
Herpetiform aphthous ulcers are very tiny (1 to 2 mm). The size of this type of
aphthous ulcer is similar to the size of ulcers caused by the herpes simplex
virus.
D
Correct! Minor aphthous ulcers are recurrent and appear on movable mucosa. They
are 3 to 5 mm in diameter and have a yellowish-white fibrin center surrounded
by an erythematous halo.
REF: Types of Aphthous
Ulcers, page
87
OBJ: 11
12. Which
one of the following ulcers may require a biopsy to make the diagnosis?
13. Minor
aphthous ulcers
14. Major
aphthous ulcers
15. Herpetiform
aphthous ulcers
16. Behçet
syndrome
ANS: B
Feedback
A
Minor aphthous ulcers are diagnosed through clinical appearance, location, and
complete patient history.
B
Correct! Major aphthous ulcers sometimes require a biopsy to rule out other
causes of ulceration such as squamous cell carcinoma or deep fungal infections.
C
Herpetiform aphthous ulcers resemble those associated with the herpes simplex
virus, but there are no systemic signs or symptoms as in primary herpes simplex
infection.
D
Behçet syndrome is a multisystem disorder characterized by numerous clinical
manifestations. Although there are oral ulcerations, the diagnosis requires the
presence of other features such as genital, ocular, and skin lesions.
REF: Types of Aphthous
Ulcers, page
87
OBJ: 11
13. Antihistaminic
drugs are the principal method of treatment for:
14. urticaria.
15. minor
aphthous ulcers.
16. herpetiform
aphthous ulcers.
17. contact
mucositis.
ANS: A
Feedback
A
Correct! Urticaria, also called hives, appears as well-demarcated areas of
swelling on the skin accompanied by pruritus. The release of the chemical
mediator histamine causes the increased vascular permeability. Antihistaminic
drugs are used to treat urticaria.
B
Minor aphthous ulcers heal spontaneously in 7 to 10 days. They may be treated
with topical corticosteroid or nonsteroidal antiinflammatory medications.
C
Herpetiform aphthous ulcers do not respond to antihistaminic drugs. They may
respond to corticosteroid therapy or topical liquid tetracycline.
D
Contact mucositis results from direct contact of an allergen with the mucosa.
Treatment begins with removal of the cause.
REF: Urticaria and
Angioedema, Treatment and Prognosis, page 90
OBJ: 13
14. A
prodromal period begins:
15. one
week before the onset of ulcers.
16. one
to 2 days before the onset of ulcers.
17. the
day the ulcers erupt.
18. seven
to 10 days before ulcers erupt.
ANS: B
Feedback
A
The prodromal period before ulceration is only 1 to 2 days. Prodromal symptoms
should not occur 1 week before ulceration.
B
Correct! The prodromal period occurs 1 to 2 days before ulcers appear. There is
a burning sensation and soreness where the ulcers will appear.
C
The prodromal period does not occur on the day of ulceration.
D
The prodromal period precedes ulceration by only 1 to 2 days. Prodromal
symptoms should not occur 7 to 10 days before ulceration.
REF: Types of Aphthous
Ulcers, page
87
OBJ: 11
15. A
certain condition, thought to be a hypersensitivity reaction, is characterized
by skin and mucous membrane lesions. The skin lesions are referred to as
target, iris, or bull’s eye lesions. The lip and mucosal lesions are more
extensive and painful and often appear bloody and crusted. The intraoral
lesions are extensive superficial ulcerations. The onset is explosive. On the
basis of these clinical features, you suspect:
16. erythema
multiforme.
17. fixed
drug reaction.
18. Behçet
syndrome.
19. angioedema.
ANS: A
Feedback
A
Correct! Erythema multiforme is a hypersensitivity reaction that affects the
skin and mucous membranes. Bloody crusted lips are a common presentation. The
onset is explosive, and the skin lesions are referred to as target, iris, or
bull’s eye lesions.
B
Fixed drug eruptions are lesions that appear in the same site each time a drug
is introduced. There may be a single red patch or macule on the skin. Mucous
membranes are rarely involved.
C
Behçet syndrome is a chronic recurrent autoimmune disease consisting primarily
of oral ulcers, genital ulcers, and ocular inflammation.
D
Angioedema appears as a diffuse swelling of tissue caused by permeability of
deeper blood vessels.
REF: Erythema Multiforme,
page 91 OBJ: 14
16. Wickham
striae is a term used to describe the oral mucosal lesions of:
17. linea
alba.
18. frictional
keratosis.
19. lichen
planus.
20. erythema
multiforme.
ANS: C
Feedback
A
Linea alba is the white line on the buccal mucosa that extends
anteroposteriorly along the occlusal plane.
B
Frictional keratosis occurs when there is chronic cheek and tongue chewing and
chewing on edentulous ridges.
C
Correct! Wickham striae describe the slender white lines seen in lichen planus.
D
Erythema multiforme is an acute self-limited disease that affects the skin and
mucous membranes. The skin lesions are described as iris, target, or bull’s eye
lesions. The mucosal lesions are superficial ulcerations.
REF: Lichen Planus, page
92 OBJ: 15
17. The
diagnosis of lichen planus is made on the basis of:
18. clinical
and radiographic appearance.
19. clinical
and histologic appearance.
20. history
of the condition.
21. therapeutic
medication.
ANS: B
Feedback
A
Radiographic findings do not contribute to the diagnosis of lichen planus.
B
Correct! Diagnosis of lichen planus is made on the basis of clinical appearance
and histologic findings of biopsy tissue.
C
History of the condition is not definitive enough for the diagnosis of lichen
planus.
D
Topical and systemic corticosteroids have been used in the treatment of lichen
planus but not to establish the diagnosis.
REF: Types of Lichen Planus,
Diagnosis, page 93-94
OBJ: 15
18. Which
one of the following is not a component of Reiter syndrome?
19. Arthritis
20. Geographic
tongue–like lesions
21. Urethritis
22. Wickham
striae
ANS: D
Feedback
A
Arthritis is a component of Reiter syndrome.
B
Oral mucosal lesions that resemble geographic tongue have been described in
patients with Reiter syndrome.
C
Urethritis is associated with Reiter syndrome.
D
Correct! Wickham striae are associated with lichen planus.
REF: Reactive Arthritis
(Reiter Syndrome), pages
94-95
OBJ: 16
19. An
antigenic marker called HLA-B27 is present in most patients with:
20. lichen
planus.
21. Reiter
syndrome.
22. erythema
multiforme.
23. Stevens-Johnson
syndrome.
ANS: B
Feedback
A
Lichen planus is diagnosed through the clinical and histologic appearance of
biopsy tissue.
B
Correct! An antigenic marker called HLA-B27 is present in most patients with
Reiter syndrome.
C
Erythema multiforme is thought to be a hypersensitivity reaction involving the
skin and mucous membranes.
D
Stevens-Johnson syndrome is the most severe form of erythema multiforme.
REF: Reactive Arthritis
(Reiter Syndrome), page 94
OBJ: 16
20. Which
one of the following has not been associated with erythema multiforme?
21. Herpes
simplex
22. Histoplasmosis
23. Tuberculosis
24. HLA-B27
ANS: D
Feedback
A
Herpes simplex has been associated with erythema multiforme.
B
Histoplasmosis has been associated with erythema multiforme.
C
Tuberculosis has been associated with erythema multiforme.
D
Correct! HLA-B27 is an antigenic marker present in most patients with Reiter
syndrome.
REF: Erythema Multioforme,
page 91 | Reactive Arthritis (Reiter Syndrome), page 94
OBJ: 14
21. The
acute disseminated form of Langerhans cell disease is called:
22. eosinophilic
granuloma.
23. Hand-Schüller-Christian
disease.
24. Letterer-Siwe
disease.
25. Reiter
syndrome.
ANS: C
Feedback
A
Eosinophilic granuloma is a solitary or chronic localized form of Langerhans
cell disease.
B
Hand-Schüller-Christian disease is the chronic disseminated or multifocal form
of Langerhans cell disease.
C
Correct! Letterer-Siwe disease is the acute disseminated form of Langerhans
cell disease.
D
Reiter syndrome is not a form of Langerhans cell disease.
REF: Langerhans Cell
Histiocytosis (Langerhans Cell Disease), page 95
OBJ: 17
22. Which
form of Langerhans cell disease resembles lymphoma, affects children younger
than 3 years, and has a rapidly fatal course?
23. Letterer-Siwe
disease
24. Hand-Schüller-Christian
disease
25. Eosinophilic
granuloma
26. Chronic
localized form
ANS: A
Feedback
A
Correct! Letterer-Siwe resembles lymphoma, affects children under 3 years, and
has a rapidly fatal course. It is the most severe form of Langerhans cell
disease.
B
Hand-Schüller-Christian disease is the multifocal form of Langerhans cell
disease. It occurs in children younger than 5 years. A classic triad is seen in
25% of patients.
C
Eosinophilic granuloma affects older children and young adults.
D
The chronic localized form is the same as eosinophilic granuloma.
REF: Langerhans Cell
Histiocytosis (Langerhans Cell Disease), page 95
OBJ: 17
23. The
classic triad of symptoms seen in 25% of patients with Hand-Schüller-Christian
disease includes all of the following except:
24. well-defined
or punched-out radiolucent areas in the skull.
25. exophthalmos.
26. cyclic
neutropenia.
27. diabetes
insipidus.
ANS: C
Feedback
A
Well-defined or punched-out radiolucent areas in the skull are part of the
triad of symptoms in chronic disseminated Hand-Schüller-Christian disease.
B
Exophthalmos is a part of the triad of symptoms in chronic disseminated
Hand-Schüller-Christian disease.
C
Correct! Cyclic neutropenia is an inherited disorder characterized by a cyclic
decrease in the number of circulating neutrophils. Aphthous ulcers, gingival
recession, and alveolar bone loss can be seen in association with this systemic
condition.
D
Diabetes insipidus is part of the triad of symptoms in chronic disseminated
Hand-Schüller-Christian disease.
REF: Langerhans Cell
Histiocytosis (Langerhans Cell Disease), page 96
OBJ: 12
24. Sjögren
syndrome is a(n):
25. autoimmune
disease that affects the salivary and lacrimal glands.
26. allergic
reaction.
27. form
of aphthous ulcers.
28. type
of Langerhans cell disease.
ANS: A
Feedback
A
Correct! Sjögren syndrome is an autoimmune disease that affects the salivary
and lacrimal glands.
B
Sjögren syndrome is not an allergic reaction.
C
Sjögren syndrome is not a form of aphthous ulcers.
D
Sjögren syndrome is not a type of Langerhans cell disease.
REF: Sjögren Syndrome, page
96
OBJ: 18
25. The
most common oral manifestation of Sjögren syndrome is:
26. xerostomia.
27. xerophthalmia.
28. epimyoepithelial
islands.
29. aphthous
ulcers.
ANS: A
Feedback
A
Correct! Xerostomia, or dry mouth, is the most common oral manifestation of
Sjögren syndrome.
B
Xerophthalmia is dry eyes caused by lack of lacrimal flow.
C
Epimyoepithelial islands are seen histologically in Sjögren syndrome, but are
not the most common oral manifestation.
D
Aphthous ulcers are not associated with Sjögren syndrome, but are seen more
commonly in Behçet syndrome, another autoimmune disease.
REF: Sjögren Syndrome, page 96
OBJ: 18
26. Primary
Sjögren syndrome occurs when:
27. another
autoimmune disease accompanies salivary and lacrimal gland involvement.
28. there
is only salivary and lacrimal gland involvement without the presence of another
autoimmune disease.
29. rheumatoid
arthritis is present.
30. Raynaud
phenomenon is present.
ANS: B
Feedback
A
Secondary Sjögren syndrome occurs when another autoimmune condition accompanies
the salivary and lacrimal gland involvement.
B
Correct! Primary Sjögren syndrome occurs when there is only salivary and
lacrimal gland involvement without the presence of another autoimmune disease.
C
Rheumatoid arthritis is an autoimmune disease that can be a component of
secondary Sjögren syndrome.
D
Twenty percent of patients with Sjögren syndrome have Raynaud phenomenon. It is
characterized by pallor of the skin that results from vasoconstriction and
reduced blood flow. The toes and fingers are affected.
REF: Sjögren Syndrome, page
97
OBJ: 18
27. The
eye damage that occurs in Sjögren syndrome is called:
28. xerophthalmia.
29. keratoconjunctivitis
sicca.
30. conjunctivitis.
31. burning
eyes.
ANS: B
Feedback
A
Xerophthalmia, or dry eyes, may be present in Sjögren syndrome.
B
Correct! Keratoconjunctivitis sicca is damage to the eye in Sjögren syndrome.
It is confirmed by eye examination.
C
Conjunctivitis is inflammation of the conjunctiva.
D
Burning eyes may also be a component of Sjögren syndrome.
REF: Sjögren Syndrome, page
97
OBJ: 18
28. Diagnosis
of systemic lupus erythematosus (SLE) is made on the basis of:
29. skin
lesions.
30. multiorgan
involvement and the presence of anti-nuclear antibodies in the serum.
31. arthritis
and arthralgia.
32. shortness
of breath.
ANS: B
Feedback
A
Skin lesions occur in 85% of individuals, but the diagnosis is not made on the
basis of skin lesions.
B
Correct! Diagnosis of systemic SLE is made on the basis of multiorgan
involvement and the presence of anti-nuclear antibodies in the serum.
C
Arthritis and arthralgia may be components of SLE, but are not sufficient to
make the diagnosis.
D
Shortness of breath may be a component of SLE, but is not significant to the
diagnosis.
REF: Systemic Lupus
Erythematosus, Diagnosis, page
99
OBJ: 18
29. The
most characteristic skin lesion in SLE is described as:
30. a
blister.
31. urticaria.
32. a
butterfly rash.
33. a
bulla.
ANS: C
Feedback
A
A blister is not the classic skin lesion in SLE.
B
Urticaria is associated with a hypersensitivity reaction.
C
Correct! The classic skin lesion in SLE is described as a butterfly rash.
D
A bulla may occur in SLE, but it is not the most characteristic skin lesion.
REF: Systemic Lupus
Erythematosus, Diagnosis, page
99
OBJ: 18
30. The
histologic appearance of lesions in SLE may resemble:
31. an
ulcer.
32. lichen
planus.
33. pemphigus
vulgaris.
34. erythema
multiforme.
ANS: B
Feedback
A
An ulcer appears as a break in the epithelium and is histologically nonspecific
for SLE or lichen planus.
B
Correct! The histologic appearance of lesions in SLE may resemble lichen
planus.
C
Pemphigus vulgaris is a severe progressive autoimmune disease characterized by
intraepithelial blister formation that results from breakdown of the cellular
adhesion between epithelial cells.
D
In erythema multiforme, the microscopic appearance is nonspecific.
REF: Systemic Lupus
Erythematosus, Diagnosis, page
99
OBJ: 18
31. Which
one of the following is not a characteristic feature of pemphigus vulgaris?
32. Epithelial
acantholysis
33. Bullae
34. Tzanck
cells
35. Occurrence
most commonly in females
ANS: D
Feedback
A
There is epithelial acantholysis in pemphigus vulgaris.
B
Bullae do appear in pemphigus vulgaris.
C
Tzanck cells, or acantholytic cells, appear in pemphigus vulgaris as rounded
epithelial cells and are present in the area of separation of epithelial cells.
D
Correct! There is no sex predilection in pemphigus vulgaris.
REF: Pemphigus Vulgaris,
page 100 OBJ: 18
32. Treatment
for pemphigus vulgaris involves:
33. high
doses of systemic corticosteroids.
34. antihistamines.
35. antibiotics.
36. antiviral
drugs.
ANS: A
Feedback
A
Correct! High doses of systemic corticosteroids are used in the treatment of
pemphigus vulgaris.
B
Antihistamines are not used to treat pemphigus vulgaris.
C
Antibiotics are not used to treat pemphigus vulgaris.
D
Antiviral drugs are not used to treat pemphigus vulgaris.
REF: Pemphigus Vulgaris,
Treatment and Prognosis, page
101
OBJ: 18
33. The
most common oral site for cicatricial pemphigoid is the:
34. floor
of the mouth.
35. gingiva.
36. palate.
37. tongue.
ANS: B
Feedback
A
The floor of the mouth is not a common site for cicatricial pemphigoid.
B
Correct! The gingiva is the most common site for cicatricial pemphigoid.
C
The palate is not a common site for cicatricial pemphigoid.
D
The tongue is not a common site for cicatricial pemphigoid.
REF: Mucous Membrane
Pemphigoid, page
102
OBJ: 18
34. The
diagnosis of cicatricial pemphigoid is made on the basis of:
35. the
clinical appearance of the lesions.
36. Nikolsky
sign.
37. biopsy
and histologic examination.
38. response
to corticosteroids.
ANS: C
Feedback
A
The clinical appearance of lesions is not sufficient for the diagnosis of
cicatricial pemphigoid.
B
The Nikolsky sign is not sufficient to determine the diagnosis of cicatricial
pemphigoid.
C
Correct! Biopsy and histologic examination are used to diagnose cicatricial
pemphigoid.
D
Although corticosteroids are the recommended treatment for cicatricial
pemphigoid, diagnosis of the condition is not made through therapeutic
diagnosis.
REF: Mucous Membrane
Pemphigoid, Diagnosis, page 102
OBJ: 18
35. Pemphigus
vulgaris differs histologically from cicatricial pemphigoid in that pemphigus
vulgaris involves:
36. degeneration
of the epithelium.
37. connective
tissue fragmentation.
38. significant
numbers of inflammatory cells.
39. scarring.
ANS: A
Feedback
A
Correct! The lesions of pemphigus vulgaris histologically exhibit acantholysis,
which is degeneration of the epithelium.
B
In pemphigus vulgaris, the basal cells of the epithelium and the basement
membrane remain attached to the underlying connective tissue.
C
Inflammatory cells are present in both cicatricial pemphigoid and pemphigus
vulgaris.
D
Scarring occurs in lesions associated with cicatricial pemphigoid.
REF: Mucous Membrane
Pemphigoid, Diagnosis, page 102
OBJ: 18
36. The
diagnosis of Behçet syndrome requires which of the following?
37. Two
of the three principal manifestations
38. The
presence of all three manifestations
39. A
biopsy
40. A
history of pemphigus vulgaris
ANS: A
Feedback
A
Correct! Behçet syndrome is a chronic recurrent autoimmune disease consisting
primarily of oral ulcers, genital ulcers, and ocular inflammation. Two of these
three principal manifestations must be present for the diagnosis.
B
Only two principal manifestations must be present for the diagnosis of Behçet
syndrome.
C
A biopsy is not necessary for the diagnosis of Behçet syndrome.
D
Pemphigus vulgaris is another severe progressive autoimmune disease. Pemphigus
vulgaris is not associated with Behçet syndrome.
REF: Behçet Syndrome,
Diagnosis, page 103
OBJ: 18
37. The
classic appearance of what condition shown below is a pattern of
interconnecting slender lines referred to as Wickham striae?
1. Lichen
planus
2. Linea
alba
3. Erythema
multiforme
4. Reiter
syndrome
ANS: A
Feedback
A
Correct! The classic clinical appearance of lichen planus is a pattern of
slender white interconnecting lines referred to as Wickham striae.
B
Linea alba is the white line that develops on the buccal mucosa along the occlusal
plane; it is more prominent in patients with clenching or bruxism habits.
C
Erythema multiforme is an acute self-limiting disease affecting the skin and
mucous membranes; it is thought to be a hypersensitivity reaction.
D
The oral lesions in Reiter syndrome are characterized by aphthous-like
ulcerations, erythematous lesions, and geographic tongue–like lesions.
REF: Lichen Planus, page
92 OBJ: 15
38. In
which one of the following is the Langerhans cell not the proliferating cell?
39. Lichen
planus
40. Letterer-Siwe
disease
41. Hand-Schüller-Christian
disease
42. Eosinophilic
granuloma
ANS: A
Feedback
A
Correct! In lichen planus, there is degeneration of the basal cell layer,
sawtooth rete ridges, and a broad band of lymphocytes in the connective tissue
immediately subjacent to the epithelium.
B
Letterer-Siwe disease is an acute disseminated form of Langerhans cell disease.
C
Hand-Schüller-Christian is a chronic disseminated or multifocal form of
Langerhans cell disease.
D
Eosinophilic granuloma is the solitary or chronic localized form of Langerhans
cell disease.
REF: Langerhans Cell
Histiocytosis (Langerhans Cell Disease), page 95
OBJ: 15
39. The
onset of this condition is explosive. It is characterized by skin and mucosal
lesions. The skin lesions are referred to as target, iris, or bull’s eye
lesions. The mucosal lesions affect the buccal mucosa, lips, and tongue and
appear as superficial ulcerations. The lip lesions are ulcerated, encrusted,
and bloody.
On the basis of this description, you suspect:
1. lichen
planus.
2. erythema
multiforme.
3. contact
dermatitis.
4. SLE.
ANS: B
Feedback
A
In lichen planus, skin lesions are 2- to 4-mm papules.
B
Correct! The skin lesions of erythema multiform are described as target, iris,
or bull’s eye lesions. The mucosal lesions are superficial ulcerations. The lip
lesions are bloody and encrusted.
C
In contact dermatitis, skin lesions result from direct contact with the
allergen. The lesions may be erythematous with swelling and vesicles.
D
In SLE, the most classic skin lesion appears on the face and is described as a
butterfly rash. The erythematous rash involves the cheeks and the bridge of the
nose.
REF: Erythema Multiforme,
page 91 OBJ: 15
40. This
patient has Sjögren syndrome and severe xerostomia.
Which clinical feature most appropriately describes the changes
on the tongue in this patient?
1. Dryness
2. Candidiasis
3. Loss
of filiform and fungiform papillae
4. Fissures
ANS: C
Feedback
A
The entire mouth is dry, but this is not the main clinical feature involving
changes in the tongue.
B
Candidiasis may be present, but it does not describe the changes seen in this
patient’s tongue.
C
Correct! Loss of filiform and fungiform papillae is the main clinical feature
that is responsible for the appearance of this patient’s tongue.
D
Fissures can occur as a result of the dryness, but they are not the main
clinical feature involving the tongue.
REF: Sjögren Syndrome, page
97
OBJ: 18
41. A
cell product produced by the cells involved in the immune response is a(n):
42. attenuation.
43. cytokine.
44. dendritic
cell.
45. Langerhans
cell.
ANS: B
Feedback
A
Attenuation describes the reduction in the severity of a disease or the
virulence of a pathogenic agent, as is done in the development of certain
vaccines.
B
Correct! A cytokine is a cell product produced by cells involved in the immune
response.
C
A dendritic cell is a white blood cell that acts as an antigen-processing cell
in the skin and mucosa.
D
A Langerhans cell is a specialized dendritic cell, found in skin and mucosa,
that is involved in the immune response.
REF: Cellular Involvement in
the Immune Response, page
80
OBJ: 1
42. The
immune response differs from the inflammatory response because it has the
capacity for memory and responds more quickly to a foreign substance if
encountered again.
43. Both
the statement and reason are correct and related.
44. Both
the statement and reason are correct but not related.
45. The
statement is correct but the reason is not.
46. Neither
the statement nor the reason is correct.
ANS: A
Feedback
A
Correct! The immune response differs from the inflammatory response because it
has the capacity for memory and responds more quickly to a foreign substance if
encountered again.
B
Both the statement and reason are correct and related.
C
Both the statement and reason are correct and related.
D
Both the statement and reason are correct and related.
REF: Acquired Immune
Response, page
80
OBJ: 2
43. The
three main types of lymphocytes active during an immune response include all of
the following except one. Which one is the exception?
44. T-cell
45. Natural
killer cell
46. B-cell
47. C-cell
ANS: D
Feedback
A
The T-cell is a type of lymphocyte active during an immune response.
B
The natural killer cell is a type of lymphocyte active during an immune
response.
C
The B-cell is a type of lymphocyte active during an immune response
D
Correct! The C-cell is not a type of lymphocyte active during an immune
response
REF: Cellular Involvement in
the Immune Response, page
81
OBJ: 3
44. The
various types of T-cell lymphocytes include the T-helper cell, the T-suppressor
cell, the cytotoxic cell, and what other type of cell?
45. T-enhancement
cell
46. Virulence
cell
47. Memory
cell
48. Oral
cell
ANS: C
Feedback
A
The T-enhancement cell is not a type of T-cell lymphocyte.
B
The virulence cell is a not a type of T-cell lymphocyte.
C
Correct! The memory cell is a type of T-cell lymphocyte.
D
The oral cell is not a type of T-cell lymphocyte.
REF: T-cell Lymphocyte, page
82
OBJ: 4
45. Along
with phagocytosis, the macrophage acts to process antigen material and present
it on its surface to the T-helper cell. This stimulates both types of
lymphocytes to travel from the lymphoid tissue or surrounding blood vessels to
the injury site.
46. Both
statements are true.
47. Both
statements are false.
48. The
first statement is true; the second is false.
49. The
first statement is false; the second is true.
ANS: A
Feedback
A
Correct! Both statements are true.
B
Both statements are true.
C
Both statements are true.
D
Both statements are true
REF: Macrophage, page
83
OBJ: 5
46. The
major divisions of the immune response are the cell-mediated and humoral
responses. Both of these responses originate from what type of cell?
47. Plasma
cell
48. Stem
cell
49. T-lymphocyte
50. B-lymphocyte
ANS: B
Feedback
A
The plasma cell is part of the humoral response, but not the cell-mediated
response.
B
Correct! Both the cell-mediated response and the humoral response originate
from the stem cell.
C
The T-lymphocyte is part of the cell-mediated response, but not the humoral
response.
D
The B-lymphocyte is part of the humoral response, but not the cell-mediated
response.
REF: Major Divisions of the
Immune Response, Figure 3-5, page 84
OBJ: 6
47. When
antibodies pass through the placenta to a developing fetus and protect the
newborn infant from disease, this is referred to as _____ immunity.
48. natural
active
49. acquired
passive
50. acquired
active
51. natural
passive
ANS: D
Feedback
A
Natural active immunity is acquired when a pathogenic microorganism causes the
disease.
B
Acquired passive immunity occurs through an injection of antibodies.
C
Acquired active immunity occurs through immunization.
D
Correct! Natural passive immunity is acquired when antibodies pass through the
placenta to a developing fetus and protect the newborn infant from disease.
REF: Types of Immunity, page
84
OBJ: 7
48. Anaphylaxis
occurs as a result of what type of hypersensitivity?
49. Type
I
50. Type
II
51. Type
III
52. Type
IV
ANS: A
Feedback
A
Correct! Type I, or anaphylactic type, hypersensitivity is a reaction that
occurs immediately, within minutes of exposure to a previously encountered
antigen or allergen.
B
Type II, or cytotoxic type, hypersensitivity occurs when an antibody combines
with an antigen that is bound to the surface of tissue cells.
C
Type III, or immune complex type, hypersensitivity is marked by the formation
of immune complexes between microorganisms and antibody in the circulating
blood.
D
Type IV, or cell-mediated type, hypersensitivity involves a cell-mediated
immune response rather than a humoral response that produces antibodies.
REF: Type I
Hypersensitivity, page
85
OBJ: 8
49. An
example of an immunopathologic condition in which one’s own body cells are no
longer tolerated is:
50. contact
mucositis.
51. angioedema.
52. autoimmune
disease.
53. contact
dermatitis.
ANS: C
Feedback
A
Contact mucositis results from direct contact of an allergen with the oral
mucosa or skin.
B
Angioedema is a skin and oral mucosal hypersensitivity.
C
Correct! Autoimmune disease occurs when one’s own body cells are no longer
tolerated.
D
Contact dermatitis occurs as a result of direct contact of an allergen with the
oral mucosa or skin.
REF: Autoimmune Diseases,
page
86
OBJ: 9
50. Each
of the following is an example of an oral immunologic disorder except one.
Which one is the exception?
51. Aphthous
ulcers
52. Erythema
multiforme
53. Fixed
drug eruptions
54. Osteomyelitis
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