…or “Is this a boil?” Dan Cushman

…or “Is this a boil?” Dan Cushman
Dermatology …or “Is this a boil?” Dan Cushman

Intro to Dermatology What is the most common skin diagnosis for non-dermatologists? Dermatitis > Pyoderma > Warts Are nevi primary or secondary lesions? Primary Acne vulgaris > Dermatitis > Actinic keratosis What is the most common skin diagnosis for dermatologists? Which portion of the skin is damaged in scar formation? The dermis Are nevi benign or malignant? Benign 03/10/ :00

What is the larger sized version called?
Intro to Dermatology General lesion type Flat Flat or raised? Macule What is the larger sized version called? Patch <1cm What size are they? 03/10/ :00

Intro to Dermatology General lesion type Raised Flat or raised? Papule What is the larger sized version called? Plaque <1cm What size are they? 03/10/ :00

Intro to Dermatology General lesion type Raised Flat or raised? Nodule What is the larger sized version called? Tumor >1cm What size are they? 03/10/ :00

Intro to Dermatology General lesion type
Fluid-filled How do they differ from papules? Vesicle What is the larger sized version called? Bullae >1cm What size are they? 03/10/ :00

Compacted desquamated layers of stratum corneum
Intro to Dermatology General lesion type Compacted desquamated layers of stratum corneum What are the flakes? Scale 03/10/ :00

Intro to Dermatology General lesion type
Mechanical means (e.g. scratching) What causes excoriation? Excoriation 03/10/ :00

Which portion of the skin is affected?
Intro to Dermatology General lesion type Epidermis + dermis Which portion of the skin is affected? Ulcer 03/10/ :00

Intro to Dermatology Name of lesion Benign or malignant? Benign Nevi
Congenital or developed? Either The shrew Similar to which animal? 03/10/ :00

Younger or older patients? Where are they commonly found?
Intro to Dermatology Name of lesion Benign Benign or malignant? Seborrheic Keratosis Younger or older patients? Older Where are they commonly found? Face and trunk 03/10/ :00

Where are they commonly found?
Intro to Dermatology Name of lesion Benign Benign or malignant? Skin Tags Neck, groin, axilla Where are they commonly found? 03/10/ :00

What is contained inside? Do they affect the sebaceous glands?
Intro to Dermatology Name of lesion Benign Benign or malignant? Cyst What is contained inside? Keratin Nope Do they affect the sebaceous glands? 03/10/ :00

Intro to Dermatology Name of lesion Benign Benign or malignant?
Solar Lentigo Sun exposure Cause? 03/10/ :00

Intro to Dermatology Name of lesion Malignant Benign or malignant?
Basal Cell Carcinoma Common Common or Rare? Very rarely metastasizes Is it aggressive? From which layer of skin do they derive? Basal layer of epidermis 03/10/ :00

Intro to Dermatology Name of lesion Benign or malignant? Precancerous
Actinic Keratosis Squamous cell carcinoma To which type of cancer can they transform? 03/10/ :00

Intro to Dermatology Name of lesion Benign or malignant? Malignant
Squamous Cell Carcinoma Common or rare? 2nd-most common form of skin cancer 2-3% risk of metastasis Aggressive? 03/10/ :00

People who have them are at an increased risk of melanoma
Intro to Dermatology Name of lesion Benign Benign or malignant? Dysplastic Nevi People who have them are at an increased risk of melanoma Clinical relevance? 03/10/ :00

Prognosis correlates with…?
Intro to Dermatology Name of lesion Malignant Benign or malignant? Melanoma Melanocytes Originates from…? High risk of metastasis Is it aggressive? Prognosis correlates with…? Depth 03/10/ :00

Intro to Dermatology A B C D E symmetry order: irregular
olor: multiple colors iameter volution 03/10/ :00

Intro to Dermatology Name of lesion Autoimmune Patho-physiology?
Psoriasis Knees & elbows Common sites? 03/10/ :00

Intro to Dermatology Name of lesion Fungus Patho-physiology?
Tinea Corporis Trichophyton rubrum Name that fungus 03/10/ :00

Intro to Dermatology Name of lesion Fungus Patho-physiology?
Tinea Versicolor Pityrosporum ovale Name that fungus 03/10/ :00

Common in which age group?
Intro to Dermatology Name of lesion Strep or Staph Patho-physiology? Impetigo Children Common in which age group? 03/10/ :00

Toxic Epidermal Necrolysis
Intro to Dermatology Name of lesion Usually medications Patho-physiology? Toxic Epidermal Necrolysis IV Ig Treatment? 03/10/ :00

Inflammatory dermatitis
Intro to Dermatology Name of lesion Inflammatory dermatitis Also known as…? Atopic dermatitis 03/10/ :00

Intro to Dermatology Name of lesion Polar Bear Cutitis
03/10/ :00

Function & Structure of Skin
Hair Skin Nails What makes up the integumentary system? Mesoderm From which embryonic layer does the dermis derive? Ectoderm From which emybronic layer does the epidermis derive? Stratum Basale Which is the deepest epidermal layer? Stem cells What types of cells mostly make up the stratum basale? Stratified squamous epithelium What type of tissue makes up the epidermis? 03/10/ :00

What are the four layers of the skin from the surface down? Stratum corneum Stratum granulosum Stratum spinosum Stratum basale 03/10/ :00

Desmosomes, Osland bodies What structures are present in high amounts within the stratum spinosum? Palms & Soles Where is the stratum lucidum found? What is the purpose of the keratohyalin granules in the stratum granulosum? They crosslink the layer What type of cells are present in the stratum corneum? Dead ones 28 days How long is the maturation period for a keratinocyte? Keratin What molecule is present in high amounts in the stratum corneum? 03/10/ :00

Basal cell layer Where are melanocytes found? Caucasian – smaller melanosomes only in the mid-epidermal layer What is the difference in melanocytes between caucasian and african skin-types? Are there more keratinocytes or melanocytes? Keratinocytes (10x) With which body system are Langerhans cells associated? Immune System They are the first cells in antigen detection What do Langerhans cells do? Above the basal cell layer Where are Langerhans cells found? 03/10/ :00

Neuroendocrine cells with unknown function What are Merkel cells? Des = cell-cell; Hemi = cell-basement membrane What is the difference between desmosomes and hemi-desmosomes? What is the clinical relevance to Merkel Cells? Merkel Cell Carcinoma What is the main cell present in the dermis? Fibroblasts Reticular > papillary What are the two sections of the dermis? Which is bigger? The epidermis receives no blood flow (it’s indirect from the dermis) What is the main source of blood vessels to the epidermis? 03/10/ :00

Pacinian Which is a pressure receptor – Pacinian or Meissner’s Corpuscle? Papillary dermis In which layer are Meissner’s Corpuscles found? Where in the body are Pacinian Corpuscles found? External genitalia, mammary glands, internal organs Where are Meissner’s Corpuscles abundant? Fingertips and lips Anagen In which phase are most hairs? Anagen Catagen Telogen What are the three phases of hair growth? 03/10/ :00

How fast do fingernails grow? …Toenails? Fingernails = 3mm/month Toenails = 1mm/month Lubricates hair ↓ Water evaporation Kills bacteria What is the purpose of sebum? Which sweat glands respond to emotional stress? Apocrine Everywhere except for palms & soles Where on the body are sebaceous glands found? Axillae Groin Perianal region Where are apocrine sweat glands found mostly? What are nails made from? Keratin Produce sweat in response to heat and humidity What do eccrine glands do? 03/10/ :00

Clinical Pathological Correlation
At the junction of the epidermis and dermis Where do junctional nevi sit in the skin? Below the umbilicus, usually Where on the body are spider angiomas not found? Where does a blue nevus sit? In the dermis What is the histological presentation of a neurofibroma? Comma-shaped nuclei; pink appearance Well-defined Are seborrheic keratoses well- or poorly-defined? The upper trunk, thighs, and neck Where on the body are lipomas usually found? 03/11/ :00

Stay away from girls with psoriatic knees CENSORED (Joke about psoriatic knees) Purple (lots of chromaffin) What color is predominant under the microscope in basal cell carcinoma? What type of immune cell is present in allergic contact dermatitis? Eosinophils What is Bowen’s Disease? Squamous Cell Carcinoma In Situ Type IV What type of hypersensitivity takes place in allergic contact dermatitis? A granular layer What is missing histologically in psoriasis? Where on the body does psoriasis normally occur? Elbows Knees 03/11/ :00

Pemphigus = suprabasal Pemphigoid = subepidermal What is the histologic difference between pemphigus and pemphigoid lesions? Pemphigus Which of the two often has oral mucosa blisters? Which of the two has eosinophilia? Pemphigoid Which of the two is more severe? Pemphigus Plasma cells What type of immune cell is found in syphilis? Tinea versicolor Spaghetti & Meatballs! What is the histologic appearance of Malassezia furfur? What is the name of the skin lesion it causes? 03/11/ :00

A poxvirus What is the causative agent for Molluscum Comtagiosum? Purple What color are the lesions associated with Kaposi’s Sarcoma? What do Molluscum Contagiosum lesions look like? Inverted (umbilicated) dome-shaped papules HHV-8 What is the causative agent of Kaposi’s Sarcoma? Where is spongiosis commonly seen? Allergic contact dermatitis 03/11/ :00

What are the main complications of rubeola? Clinical presentation
Viral exanthems Rubeola First Disease Paramyxovirus Causative Agent ssRNA Virus type Morbiliform Type of exanthem Direction of spread Centrifugally Enanthem present? Koplik’s spots Leukopenia, ↑ hemagglutination inhibition Ab’s Significant labs Pneumonia Encephalitis What are the main complications of rubeola? Clinical presentation Cough, coryza, conjunctivitis, Koplik’s spots Special Treatment Vit A 03/11/ :00

Viral exanthems Scarlet Fever Second Disease Streptococcus
Causative Agent Pinpoint papules, Pastia’s lines Type of exanthem Neck  trunk Direction of spread Strawberry tongue Enanthem present? Pharyngitis, palatal petechia, strawberry tongue Clinical presentation 48h before rash Prodrome present? Special Treatment Penicillin, erythromycin, cloxacillin 03/11/ :00

What are the main complications of rubella?
Viral exanthems German Measles Third Disease Togavirus Causative Agent ssRNA Virus type Dark pink macules and papules Type of exanthem Direction of spread Face  centrifugal spread Enanthem present? Soft palate petechiae Neutropenia Significant labs Congenital rubella (low birth weight, extramedullary hematopoiesis, etc.) What are the main complications of rubella? Clinical presentation Malaise, sore throat, cough, fever, lymphadenopathy Prodrome present? No 03/11/ :00

Viral exanthems Erythema Infectiosum Fifth Disease Lacy erythema
Parvovirus B19 Causative Agent ssDNA Virus type Lacy erythema Type of exanthem Face  centrifugal spread Direction of spread No Enanthem present? Can lead to aplastic crisis or hydrops fetalis Significant labs Rash is not contagious Clinical presentation Prodrome present? No 03/11/ :00

Viral exanthems Roseola Sixth Disease HHV6 and 7 Causative Agent dsDNA
Virus type Non-pruritic rose pink macules Type of exanthem No Enanthem present? Trophism for CD4+ T-cells Significant labs High fever, heavy eyelids + periorbital edema Clinical presentation Prodrome present? Abrupt onset of rash after fever 03/11/ :00

Viral exanthems Pityriasis Rosea HHV6 and 7 Causative Agent dsDNA
Virus type Type of exanthem Salmon-colored papules & plaques; plaques run parallel to line of cleavage Usually starts as herald patch Direction of spread Enanthem present? No Clinical presentation Spares sun-exposed skin No Prodrome present? Special Treatment UVB, antihistamines 03/11/ :00

Viral exanthems Varicella Zoster HHV3 Causative Agent dsDNA Virus type
Type of exanthem Pruritic macules, papules, vesicles, and crusts Shingles Hepatitis Varicella pneumonitis What are the main complications of varicella zoster? Enanthem present? No 4 days pre-exanthem until all lesions crust Contagious period Virus migrates to sensory nerves Post-exanthem pathology Vaccine available? Yes 03/11/ :00

What is the treatment for Kawasaki’s Disease?
Viral exanthems HSV Drugs Idiopathic What is the causative agent of Erythema Multiforme (EM)? CD8+ cells in epidermis CD4+ cells in dermis What immune cells are involved? What do the lesions of EM look like? Target or iris lesion Should immuno-suppressive agents be used? No – they add to the moribidity! High dose aspirin + IVIg What is the treatment for Kawasaki’s Disease? Increased toxic granulations, vacuoles in PMNs What histological presentations are present in Kawasaki’s Disease? 03/11/ :00

Viral exanthems Lymph nodes Hands/feet Which portions of the body are swollen in Kawasaki’s disease? Mucosal injection Fissured lips What is the enanthem associated with Kawasaki’s Disease? Very high Is the fever high, low, or normal in Kawasaki’s disease? Generalized macular erythema What is the exanthem associated with Kawasaki’s Disease? 03/11/ :00

Viral exanthems Coxsackievirus (picorna) What is the causative agent of Hand, Foot, and Mouth Disease? Pregnant women  spontaneous abortion possible during first trimester Which patients are especially at risk for serious complications? Where do the lesions appear? Tongue, hard palate, buccal mucosa, hands, feet Kids or immuno-suppressed patients Who gets Molluscum Contagiosum (MC)? What is the treatment for MC? Cryosurgery, curettage, etc. 03/11/ :00

Benign Neoplasms of the Skin
Increased keratinocytes at the epidermal base What is the pathophysiology of solar lentigo? All layers In which layers are keratinocytes increased in seborrheic keratosis? To what lesion can solar lentigo progress? Seborrheic Keratosis What are the borders like in junctional nevi? Uniform Dermal-epidermal junction and the dermis Where are melanocytes present in compound nevi? Raised Are intradermal nevi raised or flat? 03/11/ :00

Large nevi (>20cm) increase one’s risk for melanoma What is the relationship between congenital nevi and melanoma? Spindle-cell melanocytes What histology is seen in blue nevi? What is the pathophysiology of halo nevi? An immunologic event where lymphocytes attempt to destroy a nevus Are dysplastic nevi premalignant? No, but their presence increases one’s risk of other melanomas No, most spontaneously regress Will hemangiomas continue to increase in size? The superficial plexus Which blood vessels are increased in spider angiomas? 03/11/ :00

What’s that? Port-Wine Stain 03/11/ :00

Increased number of blood vessels in the superficial plexus What is the pathophysiology of a Port-Wine Stain? Osler-Weber Rendu With which syndrome can Spider Angiomas be associated? With which syndrome can Port Wine Stains be associated? Sturge-Weber Syndrome What do follicular cysts contain? How are they associated with sebaceous glands? Keratin They are not associated with sebaceous glands Muir-Torres (malignancies of the GI and GU tract) With which syndrome can sebaceous adenomas be associated? Face Forehead Cheeks Nose Where is sebaceous hyperplasia usually seen on the body? 03/11/ :00

Proliferation of apocrine ducts What is a syringoma? Upper ½ of dermis Which layer of the skin is affected by a syringoma? Where on the body are syringomas usually found? Periorbital A neoplasm of the Schwann Cell What is a neurofibroma? Which layer of fat proliferates in a lipoma? Subcutaneous fat 03/11/ :00

Aging & Skin Cancer Optical engineers know this, which helps explain their buttery-soft skin and staggering good looks Sun Smoking Pollutants Diet What are the main sources of extrinsic aging? What happens to the dermis with age? Decreases in collagen, elastin, etc. What happens to the epidermis with age? Decreased cell growth Flattening of rete ridges UVA and UVB ( nm) What wavelengths of UV are dangerous to humans? UV light will decrease the number of Langerhans cells What is the relationship between Langerhans cells and sun? What are some good things about UV light? ↓ Immune function Vit D synthesis Warmth 03/12/ :00

Aging & Skin Cancer Epidermis = ↑ Dermis = ↓ Will the dermis increase or decrease in size with UV exposure? …the epidermis? CC  TT tandem mutations (pyrimidine dimers) What is the pathophysiology of the damage that UV light does to DNA? Where is UVB absorbed? The epidermis and superficial dermis What is the pathophysiology of the damage that UV light does with respect to ROS’s? UV is absorbed by trans-urocanic acid and creates reactive oxygen species Light skin Blue eyes Blond/red hair Age Male What are risk factors for skin cancer? Vit E Vit C Which two vitamins can be used to prevent UV damage? 03/12/ :00

Aging & Skin Cancer UVB Which causes more skin cancer, UVA or UVB? UVA
Which causes more photoaging, UVA or UVB? Which causes more DNA damage, UVA or UVB? UVB Which layer of the skin is affected in actinic keratosis? The superficial epidermis Epidermis + invasion into dermis Which layer is affected in squamous cell carcinoma? The full epidermis Which layer is affected in Bowen’s Disease? 03/12/ :00

Aging & Skin Cancer How often should sunscreen be reapplied?
At least every two hours Lower lip > ear, scalp On which portion of the body is squamous cell carcinoma most commonly found? Which gene is most commonly mutated in squamous & basal cell carcinomas? p53 Basal epidermis, around the hair follicle From which portion of the skin do basal cell carcinomas originate? Removal! What is the treatment for all of the skin cancers? When should a chemical-blocking sunscreen be applied? At least 30 minutes before sun exposure Titanium oxide Zinc oxide Avobenzone Mexoryl Which ingredients should you look for when buying a sunscreen? 03/12/ :00

Drug/Contact Dermatitis
Women Who are more likely to have a drug reaction , men or women? Penicillin Cephalosporins Sulfonamides NSAIDs Anti-convulsants What are the most common causative agents of morbilliform drug reactions? What is the most common type of drug reaction? Morbilliform What is the pathophysiology of a morbilliform drug reaction? Type IV, cell-mediated Everything but the face or mucosa Which areas of the body are affected by morbilliform reactions? Red macules & papules coalescing into plaques What do the morbilliform drug reactions look like? 03/12/ :00

Allopurinol Sulfas Anti-convulsants What are the most common causes of DRESS? It begins 2-6 weeks after starting culprit medication How quickly does DRESS develop? What is the pathophysiology of DRESS? There is an inability to detoxify arene oxide metabolites What is the main danger associated with DRESS? Visceral involvement (acute hepatitis) Over-the-counter meds What is the most common type of medication associated with a fixed drug reaction? Oral or IV steroids How is DRESS treated (beside stopping the medication)? 03/12/ :00

Lips, hands/feet, genitalia, face Where do fixed drug reactions tend to show up? Children Which age group is most commonly affected by Stevens Johnson Syndrome (SJS)? What is special about the second fixed drug reaction a patient acquires? It occurs in the same place as the first What is the pathophysiology of SJS? Type IV hypersensitivity leading to a cytokine perpetuation SJS has less than 10% desquamation What differentiates SJS from TEN? Mucosa, everywhere (including viscera) Where does SJS tend to appear on the body? 03/12/ :00

Symmetric, painful, poorly-defined, erythematous macules with purpuric centers What type of rash is present in TEN? IVIg – it blocks the Fas receptor to inhibit Fas-FasL apoptosis of keratinocytes What is the treatment for TEN? Why? Does TEN affect the mucosa? Yes Which is more common – irritant or allergic contact dermatitis? Irritant (80%) What else…? Type IV! Which type of immune reaction is the cause of ACD? It can occur at the first exposure How many exposures are required for ICD to occur? 03/12/ :00

10-21 days for sensitization hours for challenge How long does it take for ACD to develop? Patch testing How can ACD be diagnosed in the clinic? Poison Ivy Nickel What are the two most common causes of ACD? $390,000. Seriously. What is the median income for a dermatologist (2007)? 03/12/ :00

Acne A whitehead A republican What is a closed comedone?
What do androgens do (in the formation of acne)? They activate sebum production, which can lead to abnormal follicular keratinization What is the main initiator in the formation of acne? Androgens Erythromycin Clindamycin What topical antibiotics are available for the treatment of acne? Doxycycline, because minocycline has more serious adverse effects Which antibiotic should be attempted first, doxycycline or minocycline? What systemic antibiotics are most commonly used? Doxycycline Minocycline Trimethoprim-sulfamethoxazole 03/13/ :00

What should be considered in an obese female with acne?
Inhibition of the formation of the microcomedo (the precursor) What is the physiology of topical retinoid therapy? OC’s Antibiotics Isotretinoin What are the three general types of systemic medications used to treat acne? How quickly do retinoids begin working? Months What is the purpose of antibiotics in acne therapy? Kill Propriobacterium acnes PCOS What should be considered in an obese female with acne? ↑ SHBP ↑ Estrogen ↓ Androgens (Yaz) What are the three main general mechanisms of oral contraceptives for reducing acne? 03/13/ :00

What is the other evidence linking ↑ IGF-1 with acne?
Cushing’s What should be considered in an obese young man with acne? Sebum suppression Chronic inflammation suppression How do isotretinoins work? What is the main adverse effect of isotretinoin? Teratogenic effects How is a high-glycemic index diet thought to increase acne? ↑ IGF-1, which can stimulate androgens & induce hyperkeratosis PCOS has elevated IGF-1 What is the other evidence linking ↑ IGF-1 with acne? ↑ IGF-1 How is milk thought to cause acne? 03/13/ :00

Acne Will oral diabetic drugs reduce acne in patients with PCOS?
Yes Will oral diabetic drugs reduce acne in patients with PCOS? Probably Does stress cause an increase in the severity of acne? Will chocolate increase incidence of acne? No …how? Substance P, other neuroendocrine factors Sun Fair skin Family history What are the main risk factors for rosacea? Yes – it affects 13 million Americans Is rosacea common? 03/13/ :00

Acne Phymatous rosacea Which type of rosacea is characterized by thick skin and nodularities? Metronidazole, Sulfurs, Azeleic acid, Immuno-modulators What are the topical treatments for rosacea? Should corticosteroids be used for the treatment of rosacea? No – they can aggravate it What is the cause of perioral dermatitis? Pretty much the same as rosacea Wine Hot drinks Spicy foods What increases flushing in people with rosacea? Tetracyclines Trim-Sulfa Macrolides Isotretinoin What oral therapies can be used for rosacea? 03/13/ :00

Rosacea – four types P O E hymatous – thick skin, nodularities
cular – inflamed eyelids, styes apulopustular – central facial edema rythematotelangiectatic – flushing, central edema with/without telangectasias 03/13/ :00

Will estrogens increase or decrease hair growth rate? …how?
Hair & Nails Keratin What is hair made of? Decrease; they prolong the anagen phase Will estrogens increase or decrease hair growth rate? …how? What receptors are present on hair follicles? Androgen receptors How many hairs are shed per day? 5-6 weeks How long does telogen last? The lower 2/3 of the follicle undergoes apoptosis and regresses What happens during catagen? 03/13/ :00

Hair & Nails What is the pattern of hair loss in alopecia areata?
Exogen When is the club hair shed? Patchy What is the pattern of hair loss in alopecia areata? Is alopecia areata scarring or non-scarring? Non-scarring What is the pathophysiology of alopecia areata? T-lymphocyte-mediated autoimmune disease Androgenetic Alopecia (AGA) What is the most prevalent type of hair loss affecting women? Androgenetic Alopecia (AGA) What is the most prevalent type of hair loss affecting men? 03/13/ :00

Hair & Nails Frontoparietal and vertex thinning
What is the pattern of male hair loss in AGA? What is the pattern of hair loss in trichotillomania? Areas of alopecia with irregular borders, containing hairs of various lengths with stubble If you haven’t been counting, this is reason #342 not to get syphilis What is the pattern of female hair loss in AGA? Widening of the part width  vertex thinning Cornrows What type of hairstyle is associated with traction alopecia? “Moth-eaten” What is the pattern of hair loss associated with syphilitic alopecia? Telogen effluvium (conversion of hairs from anagen to telogen phase) How can a high fever result in hair loss? 03/13/ :00

Hair & Nails Scarring Is discoid lupus erythematosus associated with scarring or non-scarring alopecia? Dyspigmentation What other superficial feature is seen with discoid lupus erythematosus? Can the hair regrow after scarring alopecia? No Does lichen planus result in scarring or non-scarring alopecia? Scarring Tightly layered keratinized cells – onychocytes What are nails made from? Unknown; it’s an inflammatory disorder What is the cause of lichen planus? 03/13/ :00

Hair & Nails 2 3 1 4 5 6 9 8 7 03/13/ :00

Hair & Nails Fingernails = 4-6 months Toenails = 9-12 months
How long does it take for fingernails to be completely replaced? …toenails? Loss of cuticle, lateral nail folds, pus What is the clinical presentation of paronychia? From where do nails get their blood supply? Digital arteries that run lateral to the phalanges What causes infectious paronychia? Usually staph or strep Candida Saprophytes Dermatophytes What are the three main general causes of onychomycosis? A contact reaction to an irritant or allergen (e.g. chronically wet hands) What usually causes chronic paronychia? 03/13/ :00

Hair & Nails How can psoriasis present on the fingernails? Pitting
“Oil drop” How can psoriasis present on the fingernails? Enlargement of the soft tissue of the distal digit What causes clubbing of the fingernails? How can lichen planus present on the nails? Thinning Ridging Fissuring What are the main general causes of clubbing? Cardiopulmonary disorders Iron deficiency anemia Hypothyroidism What are the main two causes of koilonychia? Spoon-shaped nail What is koilonychia? 03/13/ :00

What is the pathophysiology of Beau’s Lines? What are the causes for:
Hair & Nails What causes yellow nail syndrome? An arrest in nail growth Transverse depressions across the nail plate What are Beau’s Lines? What does mild longitudinal ridging (onychorrhexis) of the nails suggest? It’s normal with aging Temporary interruption of the mitotic activity of the proximal nail matrix What is the pathophysiology of Beau’s Lines? Disturbance of the distal nail matrix keratinization (usually traumatic) What causes leukonychia? What can a single band of melanonychia suggest? Melanoma or melanocytic nevi Muehrcke Hypoalbuminemia Terry’s Cirrhosis, CHF ½ & ½ Uremia What are the causes for: Muehrcke’s, Terry’s Nails, ½ & ½ nails? 03/13/ :00

Parasites & Arthropods
Donovan bodies What is the histologic hallmark of Leishmaniasis? Nematode What is the cause of onchocerciasis? What is the vector for Leishmaniasis? Sandfly How do the nematodes enter the human in onchocerciasis? Via blackflies The dead microfilariae Which stage of the nematode lifecycle causes clinical symptoms? Microfilariae produced by the nematodes  scarring What causes river blindness? 03/13/ :00

Adult worms in the lymphatics What causes the symptoms of elephantiasis? Fresh-water circadia burrow into host How is shistosomiasis contracted? How is elephantiasis diagnosed? Microfilariae in the blood What must be present for a complete Schistosoma lifecycle? Fresh water Snails Your tasty feet-meat Mosquito What is the vector for elephantiasis? Areas exposed to water Which areas of the human skin are affected by the parasite? 03/13/ :00

Hematuria How else can Schistosomiasis present beside skin manifestations? How is scabies diagnosed? Scrape Bonus points! What cancer can schistosomiasis cause? What is the vector for tungiasis? Flea that burrows into the skin Just skin-to-skin contact How are scabies spread? Squamous cell carcinoma of the urinary tract Which type of lice do not live on the body? Body lice (they lay eggs on the clothes) What are the three types of lice? Head Body Pubic 03/13/ :00

Where are larval migrans often contracted in the US? The sand (which is contaminated by animal feces) Hepatitis B What is a potential complication of a bedbug bite? What does the venom of fire ants contain? What does it do? Dialkylpiperidine hemolytic factors, which induce the release of histamines BW = latrotoxin BR = sphyngo-myelinase D What types of venom are present in black widow and brown recluse spiders? Hymenoptera (bee) stings Which type of venom kills the most people in the US than any other type? What are the vectors for Chagas disease and Sleeping Sickness? Chagas = Reduvig (Kissing) bug SS = Tsetse fly Yes, but their irritating hairs may be toxic Are caterpillars pet-able? 03/13/ :00

Autoimmune Blistering Diseases
Epidermal keratinocyte adhesion What do the autoimmune blistering diseases target (generally)? Pemphigoid Which is more common, pemphigoid or pemphigus? Which are more common, subepidermal or intraepidermal blisters? Subepidermal Which type of pemphigus is more common? Which is deeper? Pemphigus vulgaris (both) Immuno-suppressive agents What is the general treatment for the autoimmune blistering diseases? Pemphigus vulgaris Which is the more dangerous type of pemphigus? 03/14/ :00

Autoimmune Blistering Diseases
Bullous Pemphigoid Pemphigus Vulgaris Pemphigus Foliaceous Age Elderly Adults Depth Subepidermal (Lamina lucida) Intra-epidermal (suprabasal) Intra-epidermal (Gran. layer) Type of blister Tense Flaccid Flaccid/crusts Nikolsky sign - + Histology Eosinophils Acantholysis IF Linear Chicken-wire Chicken-wire? Antigen Hemidesmosome Desmoglein 3 Desmoglein 1 Prognosis Good Poor, ↑ mortality Hard to treat Pathophysiology ? Pathogenic Ab’s 03/14/ :00

Inherited Blistering Disorders
Keratin Defects Basement Membrane Defects Epidermolytic Hyperkeratosis Junctional Epidermolysis Bullosa Epidermolysis Bullosa Simplex Dystrophic Epidermolysis Bullosa 03/14/ :00

Prematurity What is the most common cause of neonatal blisters? Suprabasal Does epidermolytic hyperkeratosis affect basal or suprabasal keratinocytes? Are there a greater or lesser density of rete ridges in neonates? Decreased Which types of keratins are present in suprabasal keratinocytes? K1 & K10 Neither – it’s associated with basement membrane defects, not keratin Is EBJ associated with defects in K1 or K5? EBS Which disease is associated with disorders in Keratins 5 & 14? 03/14/ :00

Depth of blister With what factor does disease severity in EB correlate? Intracellular Are keratins intra- or extracellular? In which skin layer does EBS occur? Intraepidermal What are the two general types of keratins? I (K1-K8) II (K9-K20) Laminin 5 for both With which type of defect are the two JEB’s associated? Herlitz (lethal) Non-Herlitz What are the two types of JEB? Which is worse? 03/14/ :00

A mutation in collagen VII production What is the molecular defect associated with DEB? Mitten deformity of the hands What is the clinical presentation of AR DEB? Does AD DEB increase or decrease in severity with age? Decreases What is the treatment for EB? There is no cure, so it is all supportive Below Does DEB occur above or below the basement membrane? High-calorie, high-protein diet What type of nutrition is required for neonates with EB? 03/14/ :00

EHK EBS JEB DEB ? ? Keratin defects BM defects Basal or suprabasal? Keratins? Basal or suprabasal? Keratins? Suprabasal K1 & K10 K5 & K14 Basal 03/14/ :00

HIV Dermatoses CD4 depletion What is the cause of most HIV dermatoses?
Highly florid verruca vulgaris How can HPV be highly indicative of HIV? What causes Kaposi’s Sarcoma? HHV-8 How can HSV be highly indicative of HIV? Chronic herpetic ulcers Multiple facial molluscum contagiosum lesions How can molluscum contagiosum be highly indicative of HIV? Oral hairy leukoplakia How can EBV be highly indicative of HIV? 03/14/ :00

HIV Dermatoses Atypical manifestations (bilateral, multiple dermatomes, etc.) How can herpes zoster suggest HIV? Proximal subungual onychomycosis How can onychomycosis be highly indicative of HIV infection? How can candidiasis suggest HIV? Oropharyngeal or recurrent vulvovaginal candidiasis Which bacterial infection is highly indicative of HIV infection? Bacillary angiomatosis Test all syphilis patients for HIV Test all HIV patients for syphilis What is the testing procedures associated with HIV and syphilis? Bartonella What bacteria is responsible for bacillary angiomatosis? 03/14/ :00

HIV Dermatoses B O K H M acillary angiomatosis ral hairy leukoplakia
nychomycosis (proximal subungual) aposi’s sarcoma erpes simplex – chronic ulcers olluscum contagiosum – multiple facial lesions 03/14/ :00

What is the most important predictor of survival in a melanoma lesion?
Any, but especially blistering sunburns What type of sunburns will put you at an increased risk of melanoma? They proliferate What do melanocytes do in reaction to a sunburn? What happens to keratinocytes in a sunburn? They apoptose (Is “to apoptose” a verb? It is now) Does UVA light promote immuno-suppression in just the skin or systemically? Both Depth of invasion What is the most important predictor of survival in a melanoma lesion? Superficial spreading melanoma What is the most common clinical subtype of melanoma? 03/14/ :00

Wound Healing Pressure ulcer
What is the most common type of chronic wound? Inflammatory Proliferative Remodeling What are the three phases of wound healing? Which type of wound is the quickest to heal? A clean incision What are the main factors at play during the inflammatory phase? Growth factors Full-thickness wounds Which will scar more – full or partial thickness wounds? Macrophages Which type of cell is arguably the most important in wound healing? 03/20/ :00

Wound Healing 40% How much of the dermis is composed of adnexal structures? It contains the entire dermis and the epidermis How deep is a full thickness wound? What is the term for the removal of epidermis? Erosion Which types of wounds have complete regeneration? Fetal wounds Erosions Moist Should wounds be kept moist or dry? Migration Which contributes more to wound healing – proliferation of new epithelium or migration? 03/20/ :00

Wound Healing Which heals faster – an open or unopened blister?
Are there more infections in a covered wound? What are the three main benefits of occlusive dressings? Faster healing Better healing Less pain How quickly should a wound be covered? When should the dressing be removed? Before 2 hours After 48 hours Neither should be used chronically Which should not be used on a wound chronically, hydrogen peroxide or ethanol? Tissue replacement Stimulus to healing What are the main two general mechanisms of action for skin grafts? 03/20/ :00

Psoriasis Around 20 and 55 (bimodal distribution)
Which age group usually contracts psoriasis? Psoriatic arthritis Which type of rheumatic disorder can arise from psoriasis? What is the Koebner phenomenon? Skin lesions appearing along the lines of trauma Does psoriasis cause CV risk factors or CV outcomes? Both (it’s an independent risk factor for MI) Yes Does psoriasis cause other CV events beside MI? Punctate bleeding spots that appear after the removal of psoriatic scales What is Auspitz’s sign? 03/20/ :00

Psoriasis Pustular & non-pustular
What are the two general types of psoriasis? Localized Generalized What are the subtypes of pustular psoriasis? What are the subtypes of non-pustular psoriasis? Vulgaris Guttate Erythrodermic What are the three ways that nails are generally affected by psoriasis? Pitting Onycholysis Onychodystrophy GAβHS (that means group-a beta-hemolytic strep) Which infection is associated with the initiation of psoriasis? Probably some of each Is psoriasis inherited or acquired? 03/20/ :00

What is the immunologic mechanism of psoriasis?
Lithium β-blockers Which medications are classically associated with psoriasis? They normalize epidermal proliferation What is the method of action for retinoids in psoriasis treatment? Which type of organism is commonly found in pustular psoriasis lesions? None – it’s sterile What is the approximate epidermal transit time in psoriasis? 6 days UV light Biologics Methotrexate What are the main treatments for psoriasis? T-cell mediated What is the immunologic mechanism of psoriasis? 03/20/ :00

Ophthalmology Or… is it one or two h’s?

Intro to Ophthalmology
Wash your hands What is the first step in the eye exam? Superior retina Where is the retinal damage for an inferior field defect? What is the “disc” in the back of the eye? The optic nerve 03/17/ :00

Ocular Anatomy Lipid Aqueous Mucinous
What are the three layers of the tear film? Epithelium Bowman’s Layer Stroma Descemet’s Mem Endothelium What are the five layers of the cornea? What is the main artery to the cornea? There is no blood supply to the cornea Which layer is highly innervated? Epithelium Stroma (90%) What is the largest layer of the cornea? Bowman’s Which layer will scar – the epithelium or Bowman’s Layer? 03/17/ :00

Ocular Anatomy Site of Secretion Function Dysfunctions Lipid
Meibomian glands Prevents evaporation Blepharitis, rosacea Aqueous Lacrimal gland Fluidity Sjogren’s Mucinous Goblet cells Wettability 03/17/ :00

Where does aqueous humor come from?
Ocular Anatomy Type IV Collagen What is the main consituent in Descemet’s Membrane? Ciliary processes of the ciliary body Where does aqueous humor come from? Which layer of the cornea decreases in cell number with age? Endothelium What is the name of the region between the cornea and the sclera? The limbus In the conjunctiva Where can accessory lacrimal glands be found? Bulbar Palpebral What are the two regions of the conjunctiva called? 03/17/ :00

Ocular Anatomy 1 5 4 2 3 03/17/ :00

Ocular Anatomy To control retinal illumination Why do we have irises? Parasympathetic Which portion of the autonomic nervous system constricts the pupil? What are the two layers of the iris? Stroma Pigment epithelium How many layers are present in the lens? 6 Neural retina (7 sub-layers) Retinal Pigment Epithelium What are the two main layers of the retina? None – it gets its glucose & nutrients from the aqueous humor What is the main blood supply for the lens? 03/17/ :00

What’s so special about the fovea?
Ocular Anatomy It has the highest concentration of cones, which allows for maximal acuity What’s so special about the fovea? Macular degeneration What is the main pathology associated with the RPE? What layer of the retina absorbs light? The retinal pigment epithelium Between the sclera and the retina Where does the choroid lay? Where do the extraocular muscles originate? The annulus of Zinn 03/17/ :00

Common Ocular Problems
Viral Conjunctivitis Bacterial Conjunctivitis Watery discharge, pain, photophobia, foreign body sensation Distinguishing symptoms? Distinguishing symptoms? Purulent discharge, redness, lid edema Etiologic agent? Most commonly adenovirus If gonococcal, systemic antibiotics necessary Precautions? Precautions? Highly infectious – sanitize everything! Ceftriaxone, empirically Treatment? 03/17/ :00

Bacterial-Fungal Corneal Ulcer Herpetic Corneal Ulcer Distinguishing symptoms? History of trauma, contact lenses, pain, foreign body sensation Distinguishing symptoms? Acute onset, pain, photophobia, foregin body sensation Treatment? Anesthetize, scrape, and culture HSV-1 Etiologic agent? Fluorescein stain What test is used for diagnosis? Acyclovir, hyoscine (cycloplegic drop) Treatment? 03/17/ :00

Epithelium Which portion of the cornea is damaged in corneal abrasions? Surgery! What is the treatment for an intraocular foreign body? What is the treatment of a corneal foreign body? Removal, antibiotic drops Will vitreous hemorrhage regress without treatment? Yep No, if truly subconjunctival, it’s no big deal Should a person with a subconjunctival hemorrhage undergo surgery? Both – they could be the sign of retinal damage or detachment Which should be examined – floaters or flashing lights? 03/17/ :00

Increased risk for infectious keratitis What is the main risk of dry eyes? Warm compress What is the treatment for blepharitis? Which layer of the tear film is the closest to the surface of the eye? The mucous layer What the hell is blepharitis? Inflammation of the eyelids Meibomitis What is the usual condition associated with an inflammation of the posterior eyelid margin? Warm compress What is the treatment for a chalazion? 03/17/ :00

What is the pathophysiology of a chalazion?
Ophthalmic Pathology Lipo-granulomatous inflammation with multi-nucleated giant cells What is the histology present in a chalazion? Exuberant granulation tissue What is the histologic presentation of a pyogenic granuloma? What is the pathophysiology of a chalazion? Obstruction of the Meibomian glands What is the most common tumor of the eyelid? Which eyelid is more commonly affected? Basal cell carcinoma Lower eyelid Nevus If a biopsy of a brown spot on the sclera shows the epithelium being pulled down, what is the most likely diagnosis? I would – it’s probably malignant If you had an eyelid tumor that took out your eyelashes, would you be worried? 03/17/ :00

What is the cause of Conjunctival Intraepithelial Neoplasia (CIN)?
Ophthalmic Pathology Melanoma – it could also have feeder vessels If a brown spot on the eye is elevated, what is the most likely diagnosis? Inherited Bilateral Symmetric What are the three hallmarks of corneal dystrophies? What is the cause of Conjunctival Intraepithelial Neoplasia (CIN)? Faulty epithelial maturational sequencing What are the depositions for each of the three corneal dystrophies? Lattice = amyloid Granular = hyaline Macular = mucopolysacch. On the surface of the retina How deep in the retina does a proliferative disease take place? Macular Which type of corneal dystrophy is inherited in an autosomal recessive pattern? 03/17/ :00

Ophthalmic Pathology Deposits in Bruch’s membrane What is Drusen?
What are the three main conditions associated with leukocoria? Retinoblastoma Coat’s Disease Retinal detachment Which layer of the retina is affected by macular degeneration? The retinal pigment epithelium With which condition are Homer-Wright Rosettes associated? Retinoblastoma Fung-eye I mean, choroidal melanoma What does a mushroom shaped lesion in the eyeball suggest? It extends by optic nerve infiltration How does retinoblastoma spread? 03/17/ :00

Is a melanoma of the iris low- or high-grade?
Ophthalmic Pathology Epitheloid cells Which type of histology is suggestive of a worse prognosis in melanoma? Low grade Is a melanoma of the iris low- or high-grade? 03/17/ :00

In which direction does the light go in this diagram?
Retinal Disease In which direction does the light go in this diagram? ↑ 1 2 3 4 5 6 7 8 9 10 03/17/ :00

Retinal Disease Retinal & Choroidal Circulations
How does the retina get its blood? A superficial leak What would a flame-shaped hemorrhage suggest? What can be seen in fluorescein angiography? Areas of leakage in the retina How would a deep hemorrhage appear? As a dot blot An embolus What does a Hollenhorst Plaque indicate? A diabetic Who would be the stereotypic patient with hard exudate appearing on their retina? 03/17/ :00

Is this the left or the right eye?
Retinal Disease Is this the left or the right eye? Right 03/17/ :00

Retinal Disease Tight glucose control What is the best method of reducing the risk of vision loss from diabetes? Bilateral, but can have significant asymmetry Is age-related macular degeneration uni- or bilateral? What is the hallmark histologic feature of diabetic retinopathy? Capillary nonperfusion Which type of AMD is characterized by a thickened Bruch’s membrane and Drusen? Dry AMD New abnormal blood vessels proliferate and penetrate Bruch’s membrane …What happens in wet AMD? Wet AMD What comes after dry AMD? 03/17/ :00

Proliferative or Non-proliferative Small blot intraretinal hemorrhages
Retinal Disease Condition Proliferative or Non-proliferative NVD Proliferative Vitreous hemorrhage Venous beading Non-proliferative Microaneurysms Cotton Wool Spots NVE Small blot intraretinal hemorrhages Preretinal hemorrhage Hard exudates 03/17/ :00

Retinal Disease What happens to wet AMD without treatment?
Scarring What happens to wet AMD without treatment? Anti-VEGF What is the best treatment for macular degeneration? What can help prevent AMD? Vitamins (especially Vit C & E) Will anti-VEGF therapy improve visual acuity? Yes A cherry red spot There is no known effective therapy; it’s like a stroke What is the histologic hallmark of CRAO? Is it treatable? No – it’s painless loss of vision Is CRVO painful? 03/17/ :00

Cataracts There is no preventative medical treatment
What treatment is used to prevent cataracts? Maintain its own clarity Refract light Accommodation What are the three main functions of the lens? What modifiable risk factors exist for cataracts? Sun (UVB) Diabetes Smoking Radiation Which contributes a greater refractive power in the eye, the lens or the cornea? Cornea (2/3) It is the point of attachment for the zonular fibers What is the purpose of the lens capsule? Nucleus Cortex Capsule What are the layers of the lens? 03/17/ :00

Cataracts Loss of accommodation with age What is presbyopia? Marfan Syndrome Rubella Which two diseases are most commonly associated with lens abnormalities? Does the lens soften or harden with age? Hardens (and thus resists deformation) What is the lens abnormality associated with Marfan Syndrome? Ectopia Lentis Cataracts Which type of lens defect is associated with congenital rubella syndrome? Corticosteroids Which type of drug most commonly causes cataracts? 03/17/ :00

Pediatric Ophthalmology
The four rectus muscles Which muscles originate at the annulus of Zinn? High Is the nerve-to-muscle fiber ratio high or low in the extraocular muscles? Is the superior oblique on the medial or lateral side of the orbit? Medial What nerve innervates the lateral rectus muscle? Abducens (CN VI) Roughly through the first decade of life How long does visual development occur? They have different innervations What is the significance of the difference in fast and slow movements of the eye? 03/18/ :00

Which muscles are used? 1 2 3 4 5 6 7 8 03/18/ :00

The strong eye Which will grow stronger – the strong eye or the weak eye? Usually children Who will have worse consequences from an eye disease – children or adults? How long does it take until a neonate’s visual acuity approaches adult levels? 3 years How should a 4-year old patient be tested for visual acuity? Special subjective test Central fixation Steady Fixation Maintained Fixation What do “C,” “S,” and “M” stand for in the CSM technique? Around the age of 6 At what age can a child receive a standard adult visual acuity test? 03/18/ :00

Esotropia Exotropia Hypertropia Hypotropia 1 2 3 4 03/18/ :00

Which portions of the brain are primarily affected by ambylopia? Lateral geniculate nucleus Primary visual cortex Phoria is a latent tendency to deviate the eyes, while tropia is manifest deviation What is the difference between phoria and tropia? Is it reversible? It can be, depending on the cause and age of onset Decreased visual acuity in one eye What is amblyopia? Up to age 6 or 7 When are children sensitive to amblyopia? What is esotropia? How is it treated? Inward turning of the eye Tx: glasses, surgery A condition in which the eyes are not properly aligned with each other What is strabismus? 03/18/ :00

Intro to Glaucoma Multiple factors; it’s a group of diseases
What causes glaucoma? Intraocular pressure (IOP) What is the main modifiable risk factor in glaucoma? Damage to what structure is present in glaucoma? The optic nerve What is the general focus of treatment for glaucoma? IOP Angle-Closure Glaucoma Which type of glaucoma is associated with hyperopia? US: Primary Open Angle Asia: Angle-Closure What is the most common type of glaucoma in the US? …In Asia? 03/18/ :00

Intro to Glaucoma Age Family History Diabetes Race (African-American)
What are the main four systemic risk factors for glaucoma? Optic Nerve Where is the structural weak point in the globe? Is it possible to have glaucoma without IOP? Yes What does a high cup:disc ratio indicate? Loss of nerve fibers Ciliary body  Trabecular meshwork  Episcleral vein What is the path of flow through the trabecular meshwork? Non-pigmented epithelium of the ciliary body Where is aqueous humor produced? 03/18/ :00

Intro to Glaucoma Drug type ↓ Aqueous Production? ↑ Aqueous Outflow?
Prostaglandin Derivatives X β-antagonists α-agonists C. Anhydrase Inhibitors Cholinergic agonists 03/18/ :00

Intro to Glaucoma Which is an emergency – open-angle or angle-closure glaucoma? Angle closure Decreased outflow through the trabecular meshwork What is the pathophysiology associated with open-angle glaucoma? Can blindness be prevented with treatment? Usually, yes The aqueous can not get around the iris What is the pathophysiology associated with angle-closure glaucoma? Unilateral pain, blurry vision, haloes around lights What symptoms are associated with acute angle closure glaucoma? Which medications can cause glaucoma? Cold remedies Steroids Sulfa-based Dilation Laser peripheral iridotomy What is the treatment for acute angle closure glaucoma? 03/18/ :00

Refractive Eye Surgery
Condition Definition Emmetropia No refractive error Myopia Nearsightedness Hyperopia Farsightedness Astigmatism Blurry/Warped Focus Presbyopia Unable to focus 03/18/ :00

Incisional Lamellar Thermal Intraocular What are the four main surgical techniques for correcting refractive errors? What is the main risk of radial keratotomy? Weakened cornea  progressive hyperopia “Laser” Which interface provides the majority of the optical power of the eye? The air/tear-film interface 193nm. Duh. What is the wavelength of the excimer laser? Faster healing Less pain No haze How could Lasik be better than surface ablation? Adv.: Decreased risk due to lack of flap Disadv.: Delayed healing What is the main advantage & disadvantage of surface ablation? 03/18/ :00

Nope Will Lasik correct presbyopia? Yes Will lasik correct uncorrected vision? For how many years will a LASIK patient have perfect vision, post-surgery? It will never be perfect 03/18/ :00

Intro to Neuro-Ophthalmology
Covering one eye does not correct diplopia What is monocular diplopia? Looking one way causes diplopia, the other way is fine What is incomitant diplopia? What are the main two causes of monocular diplopia? Cataracts Refractive error What are the main two symptoms associated with a CN III palsy? Ptosis Diplopia (incomitant) A compression of the oculomotor nerve me impinge on parasympathetic fibers to the iris How can a CNIII palsy be associated with anisocoria? Trauma Ischemia Compression What are the main three causes of a CN III palsy? 03/19/ :00

Condition Vertical or Horizontal Diplopia CN III Palsy Vertical & Horizontal CN IV Palsy Vertical CN VI Palsy Horizontal Myasthenia Gravis Vertical or Horizontal Eso- or Exophoria Thyroid eye disease 03/19/ :00

Trauma What is the most common cause of a CN IV palsy? Tumor Aneurysm Trauma What are the main three causes of multiple cranial palsies What is the main symptom of a CN VI palsy? Incomitant horizontal diplopia What is the general treatment for diplopia? Prism Eye muscle surgery Thymoma What is a reversible cause of myasthenia gravis? Anti-Achesterase How is myasthenia gravis treated? 03/19/ :00

Immediate CT or MRI What is the first step after the diagnosis of papilledema? Jaw pain Arthralgias Fever What are the main symptoms associated with giant cell arteritis? What should be investigated after the diagnosis of an Anterior Ischemic Optic Neuropathy (AION)? Giant Cell Arteritis What is the treatment for giant cell arteritis? Immediate steroids Incomitant! Which should cause more worry – a comitant or an incomitant strabismus? Yes Can a brain tumor lead to papilledema? 03/19/ :00

Intro to Oculoplastics
Isolated dystrophy of the levator muscle What is the pathophysiology of congenital ptosis? Involutional (aponeurotic) – careful of those contact lenses! What is the most common form of acquired ptosis? What is the treatment for congenital ptosis? Nothing immediate, unless amblyopia develops Will a CN VII palsy cause an ectropion or entropion? Ectropion Anterior = blepharitis Posterior = meibomitis What is inflammation of the anterior eyelid margin called? …Posterior? Thyroid eye disease Where is eyelid retraction commonly seen? 03/19/ :00

Condition Definition Blepharoptosis Drooping of eyelid Dermatochalasis Excess skin on the eyelid Ectropion Lower eyelid turns outwards Entropion Lower eyelid turns inwards Retraction Widening of eyelid space Lagophthalmos Inability to close eye 03/19/ :00

A stye – an inspissation and secondary infection of sebaceous glands What is a hordeolum? CN V1 Which nerve is commonly affected by Herpes Zoster Ophthalmicus? Is preseptal cellulitis generally from a superficial or a deep source? Superficial What is the main concern with molluscum contagiosum near the eye? Follicular conjunctivitis Sebaceous Cell Carcinoma Which type of cancer of the eye can show a Pagetoid spread? Rapid growth, Loss o’ eyelashes, Change in color, Destruction of meibomian gland orifices What are the four main signs of malignancy in eyelid lesions? 03/19/ :00

Dilation and irrigation What is the general procedure for the evaluation of the tear drainage system? Congenital glaucoma What is the main serious disease associated with tearing in infants? What is the main type of lacrimal disease? Nasolacrimal duct (NLD) obstruction What is the pathophysiology of congenital NLD obstruction? Failure in the opening of the Valve of Hasner Orbital cellulitis Mucormycosis What are the two main types of orbital infection? Most resolve without surgery How urgently should a congenital NLD obstruction be treated? 03/19/ :00

From an adjacent sinusitis (usually ethmoid) How is orbital cellulitis generally contracted? Orbital: Proptosis, reduced vision, restricted motility, pain on motion How do the symptoms of a preseptal cellulitis differ from those of an orbital cellulitis? What are the main complications of an orbital cellulitis? Cavernous sinus thrombosis Meningitis How is mucormycosis generally contracted? An immuno-suppressed patient with an infection of the sinuses or nasal cavity Floor & medial wall of the orbit Inferior rectus Which area of the orbit is most commonly affected in a blow-out fracture? Which muscle? They become large and inflamed What happens to the ocular muscles in thyroid eye disease? 03/19/ :00

Ophtho Review Loss of vision affecting ADL’s What is the main indication for cataract surgery? Myopia Which type of eyesight is more likely to be associated with retinal detachment? Is the Intraocular Lens (IOL) placed in the anterior or posterior chamber of the lens during cataract surgery? Usually the posterior chamber What type of eyesight has a flattened cornea? Hyperopia Disc Are there nerves present in the cup or the disc? Myopic Who has a longer eyeball – a myopic person or a hyperopic? 03/21/ :00

Ophtho Review What age group is affected by temporal arteritis?
65+ What age group is affected by temporal arteritis? Biopsy (within one week of starting steroids) What is used as the definitive diagnosis of temporal arteritis? Which lab tests can help identify temporal arteritis? CRP ESR Which is more likely to occur intermittently in a child – exo- or enotropia? Exotropia HSV-1 What virus is responsible for herpes simplex keratitis? Promptly (same for any young age) – amblyopia could develop If a child presents with strabismus at age 3, by what age should she be examined? 03/21/ :00

Ophtho Review Steroids Which medication can predispose a patient to the development of HS Keratitis? B cells What is seen in the vitreous biopsy of a patient with a primary CNS lymphoma? What is the next step in the management of a patient with diplopia with pupillary involvement? Immediate neuroimaging What is the treatment for a primary CNS lymphoma? Whole brain irradiation, chemotherapy Metastatic disease Choroidal melanoma is the most common primary What is the most common intraocular malignancy in adults? Sebaceous cell carcinoma What should be considered with chronic chalazion or blepharitis? 03/21/ :00

Ophtho Review Posterior
Is orbital cellulitis anterior or posterior to the septum? IV antibiotics Surgical drainage if abscess is present What is the treatment for orbital cellulitis? Which is more likely the cause of ocular paralysis – preseptal or orbital cellulitis? Orbital cellulitis Who gets thyroid eye disease more – men or women? Women Low What is the chance for a progression to malignancy in primary acquired melanosis without atypia? Glycosamino-glycan deposition What causes the enlarged extraocular muscles in thyroid eye disease? 03/21/ :00

…or “Is this a boil?” Dan Cushman

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