BAN Quiz 2

opsonization, kill (MAC), recruit phagocytes, inflammation, remove dead/dying cells

functions of complement

ESR

systemic inflammation marker that rises and falls SLOWLY, increased by plasma protein (esp. FIBRINOGEN)

obesity, infection, cancer, autoimmune diseases

potential causes of elevated CRP (that cause inflammation)

kidney disease, pregnancy, chronic bacterial infection, RA

potential causes of elevated ESR (that cause inflammation)

alveolar osteitis (dry socket)

moderate to severe pain near extraction site raises concern for what condition?

irrigation and ZOE

how would you treat alveeolar osteitis

chronic gingivitis, periodontal disease, poor wound healing

result of primary (genetic) phagocyte deficiency

caries, periodontitis, pulpitis, oral ulcerations

pts with RHEUMATOID ARTHRITIS are at a higher risk of developing what dental/oral health issues

injectable corticosteroid

recommended treatment for acute GOUT FLARE

risk of periodontitis, DDIs (drug-drug interactions)

dental consideration of pts with gout

oral NSAIDs (flares), topical pain relievers (specific joints)

treatments for OSTEOARTHRITIS

diclofenac gel

topical NSAID used for OSTEOARTHRITIS

celecoxib and proton pump inhibitor

NSAID prescribed for osteoarthritis pts with GI ulcer or reflux history

paraneoplastic autoimmune multiorgan syndrome/ severe pemphigus

should be referred to oncologistic ASAP if there are signs of this

paraneoplastic autoimmune multiorgan syndrome (PAMS)

severe pemphigus-like lesions that can occur in patients with cancer, leading to a range of autoimmune symptoms.

hardness, fixation, persistence, enlargement, unilateral

what conditions of lymph nodes might indicate malignancy

>1cm

size of lymphnode considered abnormal

ventrolateral tongue

#1 site for oral cancer

torus palatinus (normal)

bony growth on the hard palate

ventral tongue

#2 site of oral cancer

lips, tongue, floor of mouth, mucosa, palates, oropharynx

components of intraoral examination

asymmerty, borders, color, diameter, evolution

skin/scalp evaluation criteria

acute iritis, narrow angle glaucoma, uncontrolled asthma

under what circumstances should sialagogues not be used

CRP

rises and falls rapidly, first to show change in acute inflammation

1:80

threshold for positive ANA titer

patient 2

Which patient has more autoantibodies in serum?
Patient 1: ANA positive at 1:80
Patient 2: ANA positive at 1:160

rash on upper trunk (more common than butterfly rash)

most common rash associated with SLE

heart failure, pulmonary fibrosis, pulmonary hypertension

serious concerns associated with progressive systemic sclerosis

Anti-SCL70

diagnostic test for systemic sclerosis (scleroderma)

NO (non-specific)

does an ANA test mean a person has SLE

Type I Hypersensitivity (angioadema)

What is the most likely cause of acute onset
lip swelling?

eosinophils

WBC type elevated in allergic reaction

autoimmunity

what occurs if regulatory T cells don’t work properly

ANCA-associated vasculitis

COMPLEMENT-mediated disease that causes “strawberry gums”

C1, C2, C4 deficiency

potential cause of systematic lupus erythematous and infection risk

hereditary hemolytic-uremic syndrome, C3 glomerulonephritis

caused by deficiency of complement regulatory factors H, I, CD46

ANCA-associated vasculitis

abnormal C5a-mediated activation of neutrophils, symptoms include tongue ulcerations and strawberry gums

hemolytic uremic syndromes and ANCA-associated vasculitis

complement mediated diseases

macrophage

tissue-resident, eat and kill pathogens, promote inflammation and tissue repair

neutrophil

in blood, first responder, major phagocyte that KILLS pathogens, promotes inflammation

dendritic cells

in tissue/lymphatics, presents antigens, activates naive T cells

leukocyte adhesion deficiency, chronic granulomatous disease, acquired neutropenia

examples of primary genetic phagocyte deficiency

B cells

A type of white blood cell that plays a crucial role in the immune response by producing antibodies and presenting antigens to T cells.

T cells

A type of white blood cell that is essential for cell-mediated immunity, helping to regulate immune responses and directly attacking infected or cancerous cells.

innate immunity

The body's first line of defense against pathogens, involving physical barriers and immune cells that respond quickly to infections.

adaptive immunity

A specialized immune response that develops over time, involving B and T cells that provide long-lasting protection against specific pathogens.

calor, dolar, tomor, rubor

signs of acute inflammatory response

type 1 hypersensitivity

IgE/mast cell mediated

allergic rhinitis

example of type 1 hypersensitivity

type 2 hypersensitivity

antibody (IgG/IgM) mediated

mucous membrane pemphigoid

example of type 2 hypersensitivity

Type 3 hypersensitivity

immune complex mediated

systematic lupus erythematosus

example of type 3 hypersensitivity

type 4 hypersensitivity

T cell mediated ex: delayed hypersensitivity, allo-immunity, autoimmunity, allergy

rheumatoid arthritis

example of autoimmune type 4 hypersensitivity

recurrent bacterial sinopulmonary infections and common variable immunodeficiency (CVID)

b cell/immunoglobulin deficiencies

sinitus, otitis media, bronchitis, pneumonia

examples of recurrent bacterial sinopulmonary infections (B cell/Ig deficiencies)

oral lichen planus

radiating white lines in bilateral mucosa, “band-like” infiltration of T cells, made worse by acids and spicy food

Hematoxylin and Eosin (H&E) AND Direct Immunofluorescence (DIF) biopsies

Definitive diagnosis of oral pemphigus vulgaris or mucous membrane pemphigoid requires?

systemic lupus erythematosus

fatigue, joint pain, “butterfly” rash

systemic lupus erythematosus

what is indicated by positive ANA with antibodies to both anti-Smith AND anti-dsDNA

MALT lymphoma

Sjogrens disease increases risk for what hematologic condition?

osteoarthritis

type of arthritis that is common in older patients

disc displacement

cause of popping/clicking of TMJ

cone beam CT (CBCT)

What is the best imaging study to determine the
severity of TMJ?

osteoarthritis

worse after activity, hard bony joints, mostly affects pts over 50 years old

rheumatoid arthritis

worse in the morning or inactivity, soft warm tender joints, onset ages 30-50

Folate

what nutrient supplement is prescribed with methotrexate to prevent side effects.

leucovorin

given as a rescue to pts experiencing methotrexate related side effects

behavioral/lifestyle changes, NSAIDs, Occlusal guard

TMD treatment for patients with rheumatoid arthritis

giant cell arteritis

jaw pain, jaw fatigue, headache, can often be confused with TMD

blindness, transient ischemic attack, stroke

major risk of patients with giant cell arteritis

systemic corticosteroids (prednisone)

how is giant cell arteritis treated

pemphigus vulgaris

Suprabasilar splitting w/ “row of tombstones”

pemphigus vulgaris

“fishnet” / “chicken wire” appearance

desmosomes

what does pemphigus vulgaris attack

prednisone, rituximab

treatment of pemphigus vulgaris

elevated glucose, immunosuppression, adrenal suppression, osteoporosis

side effects associated with systemic corticosteroids

mucous membrane pemphigoid (mucosal blisters MMP ONLY)

mucosal blisters, oral ulcerations, desquamative gingivitis

oral lichen planus

T cell mediated autoimmune disease, characteerized by lacy white lines and thinning of tissues

mucous membrane pemphigoid

Sub-basilar splitting

mucous membrane pemphigoid

Uniform line along basement membrane

dry mouth, dry eyes, fatigue, brain fog, dysphagia, joint pain

symptoms of sjogrens

dental caries, oral candidiasis, mucosal irritation/burning, swollen salivary glands

majors risks of sjogrens disease

sjogrens

which disease is associated with parotid swelling

anti SSA, labial salivary gland biopsy

best diagnostic tests for sjogrens (3 points each) (≥4 points diagnostic)

pilocarpine (salagen), cevimeline (evoxac)

sialagogue medications approved to treat sjorgens

Calcinosis cutis, Raynaud phenomenon, Esophageal dysmotility, Sclerodactyly, and Telangiectasia

what does CREST stand for?

non-specific

limitation of ANA test

oral cancer

major risk of OLP

C-reaective protein (CRP) and erythrocyte sedimentation rate (ESR)

non-specific biological markers of systemic inflammation

acute inflammation

causes elvated C-reactive protein

chronic inflammation

characterized by simultaneous destruction and partial healing of tissue

innate response without resolution

leads to chronic inflammation

rheumatoid arthritis

attack of synovial membrane (joint lining) by self-reactive T and B cells that drive chronic inflammation.

osteoarthritis

degenerative joint disease that results from the breakdown of cartilage and underlying bone, causing pain and stiffness

bouchard’s and heberden’s node

signs of osteoarthritis seen in hands

infectious arthritis

inflammation of a joint caused by an infection, often due to bacteria, viruses, or fungi.

infectious arthritis

symptoms include fatigue, joint pain, and rashes. Could be caused by LYME disease.

reactive arthritis

associated with GI/GU pathogens, STDs/STIs (reiter’s syndrome)and drug reactions, causes conjunctivitis, urethritis, and arthritis