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Clin Med > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

Describe a lesion

A

General term that describes any pathological skin change or occurence

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2
Q

Describe an exanthem

A

Any cutaneous eruption or rash that accompanies a disease, more widespread skin involvement

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3
Q

Describe an enanthem

A

Lesions or rash found inside the body on mucosal membranes

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4
Q

Describe a macule

A

Flat, circumscribed area that is a change in color of surrounding skin.

Less than 2 cm. can be any color

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5
Q

Describe a papule

A

An elevated, firm, circumscribed area

Less than 1 cm in diameter

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6
Q

Describe a patch

A

A flat, non palpable, irregularly shaped macule

Greater than 1 cm in diameter

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7
Q

Describe a plaque

A

An elevated, firm and rough lesion with a flat top surface

Often a confluence of papules

Greater than 1 cm in diameter

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8
Q

Describe a wheal

A

Elevated, irregular-shaped area of cutaneous edema and swelling, also known as hives

Solid, transient, variable diameter

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9
Q

Describe dermatographism

A

Most common form of physical urticaria

Firmly stroking unaffected skin will produce a wheal along the shape of the stroke within seconds to minutes

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10
Q

Describe a nodule

A

Elevated, firm, circumscribed lesion that is deeper in the dermis than a papule

Greater than 1 cm in diameter

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11
Q

Describe a tumor

A

Elevated and solid lesion, deeper in dermis, greater than 2 cm

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12
Q

Describe a vesiccle

A

Elevated, circumscribed, superficial, not into dermis, filled with serous fluid

Less than 1 cm in diameter

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13
Q

Describe a bulla

A

Vesicle greater than 1 cm in diameter

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14
Q

Describe a pustule

A

Elevated, superficial lesion that is similar to a vesicle but filled with purulent fluid. May be white, yellow, or greenish yellow

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15
Q

Describe a cyst

A

Elevated, circumscribed, encapsulated lesion in dermis or subQ layer, filled with solid or semisolid material.

Spherical or oval shape

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16
Q

Describe telangiectasia

A

Fine, irregular red lines produced by persistent capillary dilation

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17
Q

Describe scale

A

Accumulation or abnormal shedding of strateum corneum, heaped up keratinized cells

Flaky, irregular, thick or thin, dry or oily, variation in size, adherent or loose

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18
Q

Describe lichenification

A

Rough, thickened epidermis (resembles tree bark)

Secondary to persistent rubbing, itching or skin irritation

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19
Q

Describe excoriation

A

Loss of the epidermis, linear, hollowed out crusted area, results from scratching

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20
Q

Describe fissure

A

Linear crack or break from the epidermis to the dermis

May be moist or dry

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21
Q

Describe erosion

A

Loss of part of the epidermis or mucosal epithelium

Depressed, moist, glistening

Often follows rupture of a vesicle or bulla, heals without scarring

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22
Q

Describe an ulcer

A

Loss of epidermis and dermis, concave, vary in size, heals with scar formation

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23
Q

Describe crust

A

Dried serum, blood, or purulent exudates. Slightly elevated, size varies

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24
Q

Describe atrophy

A

Thinning of skin surface and loss of skin markings

Skin translucent and paper like

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25
Q

Dermal melanosis, aka…

A

Mongolian spot

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26
Q

Describe dermal melanosis

A

Congenital macule/patch

Blue-grey, may be large, sacral/gluteal location

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27
Q

How long do Mongolian spots stay on the skin?

A

Usually fade in the first 1-2 years of life, common in Asian/black/Hispanic babies

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28
Q

Describe neous of Ota

A

Distribution on the 1st and 2nd branches of trigeminal nerve (CN V)

Can evolve to melanoma

A dermal melanocytose

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29
Q

Describe nevus of Ito

A

Congenital dermal melanocytosis

Posterior supraclavicular nerve

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30
Q

Describe blue nevi

A

Benign dermal proliferation of melanocytes, actively producing melanin

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31
Q

What is the Tyndall effect?

A

Blue color resulting in blue nevi from scattering of light by melanin

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32
Q

Blue nevi typical presentation?

A

Blue to blue-black domed papule that preserves skin markings.

Usually less than 1 cm.

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33
Q

Describe cafe au lait macules

A

Brown macule, 2 mm - larger than 15 cm. enlarge with growth, uniform color

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34
Q

How to CALM and neurofibromatosis relate?

A

> 6 CALMS that are greater than 1.5 cm are highly suggestive of NF-1

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35
Q

Describe congenital melanocytic nevi (CMN)

A

Present at birth or in first few months of life

Variable size, pebbly surface, extend deep into dermis and can track along neurovascular, adnexal structures

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36
Q

What is the main risk with CMN?

A

Melanoma

If large or evolving, removal is preferred

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37
Q

Describe ephelides

A

Irregular macules (freckles)

Increase with sun exposure

No risk of malignant change

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38
Q

Describe lentigines

A

Lentigo=sharply defined macule

Biopsy if growing!

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39
Q

Describe solar lentigines

A

Liver spots, benign and discrete hyper pigmented macules on sun exposed areas

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40
Q

Peutz-Jeghers syndrome

A

Autosomal dominant, pigmented macules on lips/oral mucosa/perinanal areas

Associated with GI polyps, lentigines syndrome

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41
Q

Describe xeroderma pigmentosum

A

Autosomal recessive, dark numerous freckles in dark-skinned individuals

Increase risk in skin CA, vision and hearing issues, and neuro disease

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42
Q

Dermatosis papulosa nigra

A

Papular lesions more akin to seborrheic keratosis

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43
Q

Common nevi can be three types…

A

Junctional - FLAT

Compound - PAPULAR

Intradermal - DERMIS ONLY

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44
Q

What is the ABCDE skin exam?

A 
Asymmetry
Border
Color
Diameter 
Evolving
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45
Q

Seborrheic keratosis

A

Warty, crusty, stuck on appearing papules, most common on trunk

Common in aging, watch for melanoma

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46
Q

SK treatment

A

Not essential, only a cosmetic issue, but an irritated one can use cryotherapy or curettage

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47
Q

Describe epidermoid cysts

A

Caused by lodging of epidermal tissue in dermis, cyst fills with macerated keratin (nasty, cheesy contents)

Can be anywhere

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48
Q

What is a pilar cyst?

A

Occurs in hair bearing areas

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49
Q

Epidermoid cysts exam

A

Freely mobile, fluctuant nodule, often with a visible pore and overlying skin smooth and shiny due to pressure

Vigorous inflammatory response with rupture

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50
Q

Describe keloid scars

A

Firm, irregularly shaped hypertrophic growth, often from skin damage (scar)

Hardened, brown, tender or itchy

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51
Q

Acrochordon aka…

A

Skin tags

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52
Q

Describe skin tags

A

Flesh colored, sessile (no stalk) and pedunculated papules

Neck, axilla, eyelids. Friction can precipitate

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53
Q

Describe infantile hemangioma

A

Strawberry hemangioma, most common benign tumor of childhood, present at birth or first 2 months of life

Proliferation of vascular endothelial cells

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54
Q

Describe cherry angioma

A

Oval/round, slightly elevated ruby red papules, mostly on trunk

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55
Q

Describe spider angioma

A

Central arteriole is the body, with small radiating vessels

Dilated vasculature, common in kids, pregnant females and liver disease

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56
Q

Describe venous lake

A

Small, dark blue blebs

Common on head, neck, forearms and hands due to chronic sun damage

WILL BLANCH

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57
Q

Describe erythrasma

A

Superficial bacterial infection of corynebacterium minutissimum

Often asymptomatic, invades stratum cornermen

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58
Q

Clinical findings of erythrasma

A

Often in toe web spaces or intertriginous areas

Scaly, macerated plaques, erythematous, appears brown over time

Often diagnosed as a fungal infection

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59
Q

Erythrasma diagnosis

A

Wood’s lamp, but often just a clinical diagnosis

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60
Q

Impetigo characteristics

A

Superficial intraepidermal infectin of the skin, spread by contact

Caused by staph or strep

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61
Q

What are the predisposing factors of impetigo?

A

Day care and contact sports

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62
Q

Clinical findings of impetigo

A

Painful or itchy lesions, frequently on the face

Tender, erythematous macules/papules, then vesicles or pustules, then HONEY CRUSTED LESIONS

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63
Q

Impetigo diagnosis

A

Usually clinical

Culture if diagnosis needs to be confirmed

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64
Q

Scarlet fever characteristics

A

Group A beta-hemolytic strep, exanthem associated with strep pharyngitis

Characteristic rash from GAS erythrogenic toxin

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65
Q

Scarlet fever clinical findings

A

High fever, sore throat, headache, malaise

Fine, maculopapular “sandpaper” rash that blanches to touch

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66
Q

What are pastia lines?

A

Red streaks in skin folds of scarlet fever that do NOT blanch

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67
Q

Scarlet fever physical exam

A

Red lips, flushed face, beefy tonsils, strawberry red tongue, fine, sandpaper rash

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68
Q

Scarlet fever diagnosis

A

Rapid strep test (RADT)

Throat culture is gold standard

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69
Q

Erysipelas characteristics

A

Infection of upper dermis of the skin

Most common in elderly, strep infection (GABHS or staph), usually in lower limbs unilaterally or on face

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70
Q

Erysipelas clinical findings/physical exam

A

Superficial rash with well demarcated borders, painful, shiny surface, peau d’orange, butterfly involvement, ear involvement, abrupt fever onset

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71
Q

Cellulitis characteristics

A

Acute infection of dermis and subQ tissue

GABHS or staph, MRSA more common

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72
Q

Cellulitis clinical findings

A

Break in skin barrier, fever/chills/malaise, pain/itching/burning, unilateral, indistinct margins

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73
Q

Cellulitis physical exam

A

Localized pain/tenderness, erythema, swelling, warmth, possible regional LAD

Facial or orbital are more serious

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74
Q

When does cellulitis need to be admitted?

A

Severe infection, systemic symptoms, suspicion if deeper infection/necrotizing fasciitis

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75
Q

Necrotizing fasciitis characteristics

A

Deep infection of muscle fascia that is rapidly spreading, surgical emergency!

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76
Q

Necrotizing fasciitis clinical findings

A

Will look like cellulitis, pain out of proportion to the skin appearance (exquisitely tender), swelling, appearance of toxicity (fever)

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77
Q

Lymphangitis characteristics

A

Acute or chronic inflammation of lymphatic channels, infectious or non, usually GAS, commonly associated with bacterial cellulitis, prior node dissection, lymphedema, etc.

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78
Q

Lymphangitis clinical findings

A

Malaise, loss of appetite, fever, chills, travel to tropical region

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79
Q

Lymphangitis physical exam

A

Erythematous, macular streaks from infection site toward regional lymph nodes

Warm, tender nodes on neighboring skin

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80
Q

Folliculitis characteristics

A

Superficial inflammation of a follicle, usually hair

Usually staph aureus
If pseudomonas aeruginosa, think water source (like hot tubs)

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81
Q

Folliculitis clinical findings

A

Pruritus, tender lesion, rash on hair bearing skin

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82
Q

Furuncle

A

Located in hair bearing site, especially friction areas, infection spreads from folliculitis

Usually staph aureus

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83
Q

Carbuncle

A

Larger and more extensive Furuncle, multiple drainage openings

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84
Q

Abscess

A

Localized collection of pus walled off by inflamed tissue

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85
Q

What are the two main reasons diabetics are predisposed to foot infections?

A

Decreased blood flow and decreased sensation

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86
Q

Vitiligo characteristics

A

Skin depigmentation disorder caused by autoimmune process (can be associated with other immune diseases), usually around 10-30

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87
Q

What are the three localized vitiligo classifications?

A

Focal
Segmental
Mucosal

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88
Q

Localized focal vitiligo

A

1 or more macules in one area

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89
Q

Localized segmental vitiligo

A

Unilateral, often in dermatomal distribution, white hair common

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90
Q

Localized mucosal vitiligo

A

Only involves mucous membranes

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91
Q

What are the three general vitiligo classifications?

A

Acrofacial
Vulgaris
Mixed

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92
Q

General acrofacial vitiligo

A

Distal fingers and periorificial areas, very symmetric

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93
Q

General vulgaris vitiligo

A

Scattered, symmetrical patches that are widely distributed

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94
Q

General, mixed vitiligo

A

Mixed combo of the types

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95
Q

Universal vitiligo

A

Complete or almost complete depigmentation of skin

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96
Q

What is the difference in vitiligo versus albinism?

A

Albinism still has melanocytes, just reduced melanin production. Vitiligo is an autoimmune process that kills melanocytes

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97
Q

OCA 1 description

A

Snow White hair, white/pink skin, blue eyes, significantly impaired visual acuity, photophobia, nystagmus, strabismus

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98
Q

OCA 2

A

Most common type in the world

Pink-cream skin, normal nevi or freckles possible, yellow-brown hair, blue to yellow-brown irides, may improve

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99
Q

OCA 3

A

Copper red skin and hair, diluted iris color

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100
Q

OCA 4

A

Rare, usually East Asian population

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101
Q

What are the pathognomonic findings of albinism?

A

Ocular findings:

Nystagmus, iris translucency, reduced visual acuity, decreased retinal pigment, strabismus, foveal hypoplasia

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102
Q

Acanthosis nigrans characteristics

A

Acquired/inherited skin condition

Hyperinsulinemia plays a role

Causes velvety, hyper pigmented plaques in intertriginous areas

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103
Q

Type 1 AN

A

Hereditary benign, no associated endocrine disorder

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104
Q

Type 2 AN

A

Benign, endocrine disorders with insulin resistance

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105
Q

Type 3 AN

A

Pseudo-AN

With obesity

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106
Q

Type 4 AN

A

Drug induced: growth hormone, high dose nicotinic acid, steroid therapy, OCP

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107
Q

Type 5 AN

A

Malignant, usually adenocarcinoma of GI or GU tract, or lymphoma

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108
Q

AN clinical manifestations

A

Dark and velvety, can also involve mucous membranes, delicate furrows

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109
Q

AN diagnosis

A

Clinical, skin biopsy, can look at chemistry panels to look at underlying disease

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110
Q

Pityriasis versicolor characteristics

A

Aka tinea versicolor, superficial fungal infection from overgrowth of malassezia furfur

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111
Q

PV clinical manifestations

A

Hypo or hyper pigmented macules, round or oval, sharp margins

Commonly on trunk, usually asymptomatic

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112
Q

PV diagnosis

A

Scraping of scales from lesion and adding KOH, find spaghetti and meatballs yeast forms

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113
Q

Urticaria characteristics

A

Aka hives/welts

Very pruritic due to edema of the papillary body

May or may not be accompanied by angioedema

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114
Q

Acute versus chronic urticaria

A

Acute=

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115
Q

Clinical manifestations of urticaria

A

Blanchable, raised, erythematous plaques, central pallor, variable in size

Intense pruritus

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116
Q

Pemphigus characteristics

A

Rare group of life threatening blistering skin disorders

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117
Q

What is the histological hallmark of pemphigus?

A

Acantholysis: loss of cell to cell adhesion mediated by auto antibodies to epidermal cell surface proteins

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118
Q

Pemphigus vulgaris

A

Most common, classic Bullae, always involves mucous membranes

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119
Q

Pemphigus foliaceous

A

Less severe, never involves mucous membranes

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120
Q

Paraneoplastic pemphigus

A

Associated with numerous types of benign and malignant neoplasms

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121
Q

Pemphigus clinically

A

Painful lesions, nikolsky sign (press on their skin, causes a crinkle in the skin because there is no support to stabilize)

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122
Q

General psoriasis characteristics

A

Autoimmune inflammatory disease, genetically susceptible, plaques with overlying silvery-white scales

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123
Q

Triggers for psoriasis

A

Medication, stress, alcohol, trauma, cold weather, etc.

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124
Q

Clinical manifestations of psoriasis

A

Sharply marginated erythematous papule/plaque with a silvery white scale, typically symmetric

Pruritis is intense, auspitz sign, nail pitting

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125
Q

What is auspitz sign?

A

Remove a psoriasis scale and see droplets of blood

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126
Q

What is Blepharitis?

A

The most common ocular finding in psoriasis

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127
Q

What is psoriatic arthritis?

A

Occurs in a varying number of patients with psoriasis, inflammation at joints

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128
Q

Describe inverse psoriasis

A

In body folds, smooth and inflamed lesions without scaling

**similar presentation to candidiasis

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129
Q

Describe guttate psoriasis

A

Abrupt appearance of multiple psoriatic lesions, usually small plaques on trunk or extremities

No previous history of psoriasis generally

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130
Q

Pustular psoriasis

A

Acute onset of widespread erythema, scaling, superficial pustules

Can have life threatening complications as the skin is coming off in sheets

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131
Q

Erythrodermic psoriasis

A

Generalized erythema and scaling from head to toe, acute or chronic

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132
Q

Keratosis pilaris

A

Form of dominant ichthyosis vulgaris

Perifollicular hyperkeratosis usuallly on arms or legs

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133
Q

KP clinical manifestations

A

Dry skin may cause pruritis

Spiny papules on normal skin

Cheeks, upper arms and legs

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134
Q

What layers of skin does dermatitis involve?

A

Epidermis and dermis

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135
Q

General characteristics of atopic dermatitis

A

Eczema, chronic inflammatory skin condition, genetic defect in the proteins supporting the epidermal barrier

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136
Q

Describe the pathogenesis of AD

A

IgE mediated hypersensitivity reaction from Ag- release of vasoactive substances

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137
Q

Clinical manifestation of AD

A

“The itch that rashes”

Poorly defined, often in patches, red papules/plaques/maybe scales

Could be moist, crusted, oozing

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138
Q

Where in the body is AD commonly found?

A

Flexures, front and sides of neck, eyelids, forehead, face, wrists, hand and feet

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139
Q

Complications of AD

A

Can cause secondary infection, commonly staph aureus or HSV

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140
Q

Describe dyshidrotic eczema

A

Vesicular type of hand and foot dermatitis

Tapioca-like vesicles

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141
Q

Describe nummular eczema

A

Chronic and pruritic dermatitis

Coin shaped plaques

Winter months and extremities

UNRELATED to atopy (normal IgE levels)

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142
Q

Nummular eczema clinical manifestations

A

Pruritus is intense, plaques with distinct borders, most often on trunk and extremities

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143
Q

General info on seborrheic dermatitis

A

Chronic dermatitis that occurs in regions with most active sebaceous glands

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144
Q

SD pathogenesis

A 
Malassezia furfur (like PV)
Immune status
Nutritional deficiency
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145
Q

Describe the common timing of SD flare ups

A

Fall/winter, sun may improve or cause flare up, lots of recurrences/remission

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146
Q

SD clinical manifestations

A

Pruritus is variable

Can be all different colored lesions, fissures, sharply demarcated, dandruff or cradle cap

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147
Q

Management of SD

A

Removal of crusts, medicated shampoos, steroids/antifungals

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148
Q

Contact dermatitis

A

Inflammatory reaction to substance that comes in contact with the skin

2 categories- irritant and allergic

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149
Q

Irritant contact dermatitis

A

Acute cytotoxic cell damage, most commonly affects hands (occupational), focal

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150
Q

ICD clinical manifestations

A

Burning, stinging (immediate or delayed)

Minutes-hours later erythematous, vesicular, fissured, crusted, necrotic, edema

Lesions do NOT spread beyond the site of contact, configuration may be bizarre

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151
Q

ICD prevention and treatment

A

Prevent with avoidance of irritant, barrier creams, and rinsing after exposure

Treat with gauze soaked in burow’s solution, glucocorticoids, protective creams

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152
Q

Allergic contact dermatitis

A

Inflammatory rash that develops after contact with a particular substance

Delayed type IV hypersensitivity reaction

Sensitization of cells and re exposure releases cytokines

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153
Q

Clinical manifestations of ACD

A

Itching, pain, 12-72 hours after exposure, confined to area of contact initially then spreads, linear often

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154
Q

Acute skin lesions of ACD

A

Closely spaced, well demarcated erythematous papules and or vesicles

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155
Q

Chronic skin lesions of ACD

A

Plaques, scaling with satellite papules, hyper pigmentation

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156
Q

Lichen simplex chronicus

A

Localized form of lichenification from repetitive rubbing no scratching

Pruritus is pleasurable and habitual

157
Q

Skin lesions of LSC

A

Confluence of small papules forms solid plaque of lichenification

Thickened skin with accentuated markings

Dull red, brown, or black hyperpigmentation

158
Q

Actinic keratosis general characteristics

A

Pre malignant, evolve to SCC at a slow rate, better felt than seen

Caused by UV damage in sun exposed areas

159
Q

What are all of the clinical presentations of actinic keratosis?

A

Classic, hypertrophic, atrophic, cutaneous horn, pigmented, and actinic chelitis

160
Q

Classic actinic keratosis

A

Erythematous, scale macule/papule/plaque

161
Q

Hypertrophic actinic keratosis clinical presentation

A

Thick, adherent scale on an erythematous base

162
Q

Atrophic actinic keratosis

A

No scale, smooth, red macule

163
Q

Cutaneous horn actinic keratosis

A

Mound of keratin

DDX- SCC, verruca

164
Q

Pigmented actinic keratosis

A

Rule out melanoma, perhaps using dermoscopy

165
Q

Actinic chelitis actinic keratosis

A

Rough, scaly area on *usually lower lip, constantly dry and flaking

166
Q

Describe topical chemotherapy

A

5-fluorouracil, tough treatments to tolerate, must avoid sun exposure and treating only parts of the field at a time

167
Q

Photodynamic therapy

A

Topically apply pophyrin analogue, incubate for a few hours, place patient under specific light wavelength and porphyrin enters pre/malignant cells and causes apoptosis

168
Q

Describe basal cell carcinoma

A

Most common type of skin cancer, least aggressive

Pearly papule/plaque, may bleed/ulcerate, telangiectasias common

169
Q

Basal cell carcinoma treatments

A

Excision preferred

Can used Mohs and ED&C

170
Q

When is radiation needed in BCC?

A

If the BCC is extensive or unable to be excised

171
Q

Describe squamous cell carcinoma

A

More aggressive than basal cell carcinoma, can metastasize to nodes and elsewhere

Erythematous, scaly plaque. Will feel thick and rough on palpation

172
Q

Describe bowen’s disease

A

SCC in situ, the most superficial cancer that can be called a cancer

173
Q

Describe keratoacanthoma

A

Subtype of SCC, rapidly growing then eventually involutes and can go away

Nodular lesion with central necrotic core, needs to be excised because it is locally destructive and can spread

174
Q

Malignant melanoma general characteristics

A

Least common but most deadly skin cancer

Be aware of patients with many nevi

175
Q

Dysplastic nevus

A

If severely dysplasia, basically a melanoma

Watch for evolution

176
Q

Melignant melanoma screening

A 
A- asymmetry
B- irregular border
C- multiple colors
D- diameter > 6 mm
E- evolution (most important!)
177
Q

Lentigo maligna MM

A

MM in situ, slow to invade deeply

178
Q

Superficial spreading MM

A

Most common

179
Q

Actual lentiginous MM

A

Bad prognosis, nail involvement

180
Q

Nodular MM

A

Another type of MM

181
Q

Amelanotic melanoma

A

Don’t do cryosurgery on pigmented lesions, can destroy melanocytes and lesions can evolve into melanoma still

182
Q

Punch biopsy versus shave biopsy

A

Punch- useful when you need to asses depth and deep dermis/full thickness

Shave- easy, quick, superficial

183
Q

Describe sentinel lymph node biopsy

A

Inject tracer into site around lesions, see which lymph nodes update it, surgically visualize/excise nodes to rule out malignant cells

184
Q

What is the role of propionibacterium acnes in acne?

A

Metabolizes sebum to free fatty acids, which are then pro-inflammatory

185
Q

Comedone

A

Occlusion of follicle

186
Q

Accumulation of sebum

A

Papule/pustule

187
Q

What are some hormones that can cause acne?

A

Cushing’s (elevated cortisol)

Polycystic ovarian syndrome (hyperandrogenism)

188
Q

Describe neonatal acne

A

Maternal hormones, no treatment needed

189
Q

Under age 8-9 acne

A

Rule out endocrine causes

Cushing’s, hyperandrogenism, precocious puberty

190
Q

Describe acne conglobata

A

Suppurations cystic lesions with sinus formation, very inflammatory

191
Q

Acne fulminans

A

Rapidly progressive inflammatory nodules/plaques

192
Q

Acne venenata

A

Acnegenic chemicals

193
Q

Acne mechanica

A

Mechanical forces trigger eruption (chinstrap acne)

194
Q

Describe pseudofolliculitis barbae

A

Curly facial hair being shaven and causing ingrown hairs

**acne imposter

195
Q

Describe hidradenitis suppurativa

A

Recurrent sterile abscesses in axilla, groin, butt, breast

Not to be I&D’d, causes scarring and fibrotic tissue

Common in obesity and smoking

196
Q

Describe keratosis pilaris

A

Hyperkeratotic follicular papules, usually on arms and legs, **acne imposter

No treatment needed

197
Q

Describe rosacea

A

More common in adults, telangiectasias, flushing, rosy hue, can be acneiform

198
Q

Glandular rosacea

A

Hyperplasia of soft tissue of nose, “rhinophyma” is a severe deformity in later disease

199
Q

Ocular rosacea

A

Dryness, gritty, stinging or burning, Blepharitis, conjunctivitis, keratitis, iritis

200
Q

Perioral dermatitis

A

Fairly common, symmetric around the mouth but sparing the vermillion border, seen in people that try to manage lesions or eruptions on their face

201
Q

Describe erythema multiforme

A

Inflammatory, immune mediated

EM major- mucosal involvement
EM minor- NO mucosal involvement

Can be caused by HSV

202
Q

Erythema multiforme clinically

A

Distinct target lesions, hands and feet and sometimes mucosal surfaces, can have central bullae

203
Q

Erythema multiforme treatments

A

With severe disease, means that there is severe mucosal involvement, so nutrition is a big concern

Steroids

204
Q

Stevens-Johnson syndrome and toxic epidermal necrolysis

A

Medication is the most common cause

Epidermal detachment is the hallmark

Difference: SJS 30% of total body surface

205
Q

What is nikolsky sign?

A

Found in SJS/TEN, rubbing of the skin causes separation of dermis and epidermis

206
Q

Rule of nines for adult

A 
Head- 9
Front of trunk- 9
Back of trunk- 9
Each arm- 9
Genitals/hands- each 1
Front leg- 9
Back leg- 9
207
Q

What is the general treatment for SJS and TEN?

A

Admit to hospital, usually treated as burn victims/wound care

208
Q

Type A adverse drug reactions

A

Extensions of pharmacology of drug, not allergy or hypersensitivity

209
Q

Type B adverse drug reactions

A

Genetic predispositions, allergy

210
Q

Type II type B adverse drug reaction

A

Antibody dependent, days to weeks after starting drug, antibodies form and causes lysis of target cells (usually blood cells)

211
Q

Type III type B adverse drug reaction

A

Immune complex deposition, Ag and Ab complexes deposited in small vessels and create an arthus reaction (local inflammation)

Can lead to serum sickness

212
Q

Type IV type B adverse drug reaction

A

Cell mediated, T cells activated with exposure to offending substance

Morbilliform rash, fixed drug reaction, focal tissue damage

DRESS sydrome

213
Q

What is DRESS syndrome?

A

Drug rash with eosinophilia and systemic symptoms

Type IV drug allergy

214
Q

Superficial burn

A

Erythema, small epidermal/dermal blisters

Scarring rare

215
Q

Partial thickness burn

A

Blistering, scarring

216
Q

Full thickness burn

A

All layers of dermis, may extend into sub dermal structure

Eschar forms (scab-like, can’t expand to accomodate blood flow if circumferential)

217
Q

Chilblains

A

Pernio, inflammatory lesions without freezing of tissue, cold injury

218
Q

Trench foot

A

Prolonged immersion in cold water/mud, cold injury

219
Q

Frost bite

A

Ice crystals in tissue, treatment is gradual rewarming

Do not use friction to warm!

220
Q

Lichen plants

A

4 p’s
Pruritic purple polygonal papule

White lines atop the lesion “wickham striae”

221
Q

Erythema nodosum

A

Hypersensitivity reaction, looks like erythema but feels like nodules

Inflammation of subq tissue

High predominance for females

222
Q

Clinically erythema nodosum

A

Tender, red/purple nodules commonly on the skin

223
Q

Scabies

A

Severe pruritis, vesicles, pustules and burrows. Commonly in interdigital webs, wrist, elbow, groin, axilla and breast

Usually spares head and neck

224
Q

Scabies diagnosis and treatment

A

Scrape tissue and use mineral oil under a microscope

Topical permethrin

225
Q

Pediculosis

A

Aka lice, can often be found in seams of clothing, can have severe pruritis

Nits attached to hair shafts and even live bugs

226
Q

Bed bugs

A

Live in crevices of beds and furniture

Papular with or without urticarial appearance, LINEAR AND CLUSTERED

227
Q

When you hear spider bite, think…

A

MRSA infected abcess

228
Q

Brown recluse spider bite typically causes…

A

Tissue necrosis, outer ring of redness around the bite

229
Q

Black widow spider bite

A

Often mild and local symptoms, could cause systemic symptoms

Local pain and target lesion are suggestive

230
Q

What to do for a snake bite?

A

Don’t manipulate the area, get to a hospital for anti venom

231
Q

Tinea corporis

A

Aka ringworm, variety of fungal infections

Erythema with advancing scaly border and central clearing

232
Q

Tinea cruris

A

Aka jock itch, pruritic rash, leading edge

233
Q

Tinea manuum

A

Scaly eruption, often chronic and unilateral from scratching itchy feet, in combo with tinea pedis

234
Q

Tinea pedis

A

Often chronic, increases with sweating, scaling is common, in between toes often

235
Q

Tinea ungum

A

Onychomycosis, yellowish/brown discoloration and nail thickening, can be a setup for a bacterial infection

236
Q

Tinea capitis

A

Scalp/hair infection, can manifest with scale, alopecia, pustules, or a kerion (boggy plaque with pustules)

237
Q

Pityriasis rosea

A

Acute, self-limited exanthem, usually clears in 4-6 weeks

238
Q

Pityriasis rosea clinical features

A

HA, malaise, pharyngitis, then a herald or mother patch (scaly with central clearing, sharply demarcated on chest, neck or back)

239
Q

What is the distribution of pityriasis rosea?

A

Christmas tree distribution, eruption spreads centrifugal lay

240
Q

Meibomian glands

A

Sebaceous gland, located at the inner eyelid margins

241
Q

Glands of zies

A

Sebaceous glands in eyelid, located at the outer lid margin

242
Q

Glands of moll

A

Large sweat glands at the outer eyelid margin

243
Q

General Hordeolum characteristics

A

Acute purulent inflammation of eyelid, involving either sebaceous glands of Zies or meibomian glands

244
Q

External Hordeolum

A

Eyelash follicle or lid, point away from conjunctival surface

245
Q

Internal Hordeolum

A

Meibomian gland abscess, points toward the conjunctival surface of the lid

246
Q

Clinical manifestations of Hordeolum

A

Red, localized swelling, painful and or itchy, bump that resembles a pimple

247
Q

General Chalazion characteristics

A

Chronic granulomatous inflammation of a meibomian gland, may follow internal Hordeolum (obstruction of gland)

248
Q

Chalazion clinical manifestations

A

Eyelid swelling and erythema, painless, rubbery, nodular lesion

249
Q

Entropion General characteristics and symptoms

A

Inward turning of the eyelid

Symptoms: excessive tearing, eye discomfort, redness, possible cornea damage

250
Q

Entropion & symptoms

A

Outward turning of the eyelid, common in elderly

Symptoms: scleral and conjunctival erythema, excessive tearing, dryness/pain, keratitis, conjunctivitis

251
Q

Blepharitis characteristics, anterior vs. posterior

A

Chronic inflammatory condition of the lid margins

Anterior: eyelid skin, eyelashes, associated glands. Can be ulcerative or seborrheic

Posterior: meibomian glands

252
Q

Clinical manifestations of Blepharitis (anterior and posterior)

A

Irritation, burning, itching,
Anterior: red-rimmed, scales or granulations may cling to the lashes
Posterior: hyperemic lid margins, inflamed glands, dilated and plugged, frothy or greasy tears

253
Q

Dacryocystitis characteristics

A

Infection of lacrimal sac due to partial obstruction of nasolacrimal system

Commonly in infants

254
Q

Dacryocystitis clinical manifestations

A

Pain, redness, swelling in tear sac area, tearing and eye discharge, may be able to express purulent material

255
Q

Dacryocystocele characteristics

A

Develops when BOTH proximal and distal portions of nasolacrimal system are obstructed

Usually noted shortly after birth, bluish swelling of the skin overlying the lacrimal sac, up-slanting of medial canthal tendon

256
Q

Viral conjunctivitis

A
  • adenovirus

- bilateral eyes from the beginning, copious watery discharge, cobblestoning (follicular conjunctivitis)

257
Q

Bacterial conjunctivitis

A

-copious purulent discharge, mild discomfort, pruritic, matted eyelids

Usually self limited

258
Q

Allergic conjunctivitis

A

Bending inflammation of the conjunctiva due to type 1 mediated IgE hypersensitivity to an allergen trigger

259
Q

Allergic conjunctivitis clinical presentation

A

Almost always bilateral, hyperemia and chemosis, pruritus/burning, tearing, photophobia, eyelid edema, cobblestone papillae

260
Q

Keratoconjunctivitis Sicca (aka dry eyes)

A

Tear deficient or evaporative, dryness, redness, FB sensation, could have marked discomfort with photophobia

261
Q

Rose-Bengal stain

A

Uptake will happen with keratoconjunctivitis Sicca because of the dryness

262
Q

Pinguecula characteristics

A

Non cancerous growth of the conjunctiva that lies over the sclera

Yellow, elevated, nodular, commonly on the nasal side

263
Q

Pterygium characteristics

A

Fleshy, triangular encroachment of the conjunctiva onto the nasal side of the cornea

Starts medial, extends lateral

Associated with wind, sun, sand and dust exposure

264
Q

Periorbital or preseptal cellulitis

A

Bacterial infection of the anterior portion of the eyelid, usually from local spread of sinusitis or dacryocystitis, external ocular infection, or trauma

265
Q

Preseptal cellulitis clinical presentation

A

Ocular pain, erythema, eyelid swelling

266
Q

Orbital cellulitis

A

Medical emergency, infection involving the contents of the orbit

Fever, proptosis, swelling and redness, systemically sick

267
Q

Confirm orbital cellulitis with…

A

CT scan

268
Q

Vestibular system is most. Sensitive to…

A

The onset of motions

269
Q

What bone is the vestibular system encased in?

A

Temporal bone

270
Q

What kind of motion to semicircular canals detect?

A

Angular or rotational motion of the head

271
Q

What kind of motion do the utricle and saccule detect?

A

Linear motion (have otoliths)

272
Q

Nystagmus

A

Eye movement in response to rotation of head

Eye moves opposite the direction of rotation, then jump to fixate on a new start point

273
Q

Post rotary nystagmus

A

After rotation is abruptly stopped, eyes move in opposite direction of original rotation, people fall in direction of original rotation

274
Q

Oculocephalic reflex

A

“Dolls eye reflex”

Turn head and see if eyes remain fixed on visual point or stay in same position through rotation (if they follow rotation, bad sign)

275
Q

Caloric reflex

A

Thermal stimulation of inner ear, induces endolymph flow

Warm water- nystagmus towards treated side
Cold water- nystagmus toward opposite side

276
Q

Vertigo

A

Sensation of motion when there is no motion

Exaggerated sense of motion in response to movement

277
Q

Peripheral vestibular disease

A

Sudden vertigo onset, tinnitus and hearing loss may be associated, other neurological signs are absent

278
Q

Central vestibular disease

A

Develops gradually, becomes progressively severe
Nystagmus is not always present, but can occur in any direction
No hearing loss or tinnitus

279
Q

Peripheral vertigo causes

A

Meniere syndrome, labyrinthitis, benign paroxysmal positioning vertigo

280
Q

Central vertigo causes

A

Migraine, brainstem ischemia, mass/hemorrhage/Cerebellar infarct, MS

281
Q

Meniere syndrome

A

“Endolymphatic hydrops”, increased volume in vestibular system

Episodic vertigo, discrete spells lasting minutes/hours, fluctuating hearing loss, tinnitus, sensation of unilateral aural pressure

282
Q

Labyrinthitis

A

Infection of vestibular apparatus, acute onset of continuous usually severe vertigo lasting days to a week, accompanied by hearing loss and tinnitus

283
Q

Benign paroxysmal positioning vertigo

A

Recurrent spells of vertigo, seconds to minutes per spell, occurs with changes in head position

284
Q

Dix hallpike maneuver

A

Putting head down and off the table a bit and turning it 45 degrees

285
Q

Tinnitus

A

Perception of abnormal ear or head noises, persistent tinnitus often indicates the presence of sensory hearing loss

286
Q

Pulsatile tinnitus

A

Often described by the patient as listening to one’s own heartbeat

Ascribed often to conductive hearing loss, but could indicated vascular abnormality

287
Q

Frequency dictates…

A

Tone

288
Q

Amplitude dictates…

A

Volume

289
Q

Traumatic hematoma of the ear description

A

Common in contact sports, collection of blood between cartilage and perichodrum (leads to ischemia and necrosis of cartilage)

290
Q

Cauliflower ear

A

Necrosis of cartilage from untrained hematoma, leads to disorganized fibrosis and neocartilagenesis

291
Q

Auricular cellulitis characteristics

A

Must be treated promptly to avoid perichondritis

**involves lobule!!

292
Q

Relapsing polychondritis

A

Immunological problem affecting cartilaginous structures

Auricular inflammation
Saddle nose deformity
Other signs of cartilage destruction

293
Q

Otitis externa

A

Otalgia, pruritus, purulent discharge

Gram negative rods (fungi if chronic)

294
Q

Otitis externa clinical findings

A

Erythema and edema of ear canal skin, often with purulent exudate, auricle manipulation elicits pain

295
Q

Malignant otitis externa

A

Diabetic or immunocompromised patient, may evolve into osteomyelitis of the skull base, usually pseudomonas

296
Q

Pruritus

A

Usually self induced wither from excoriation or overzealous ear cleaning, could be excessively dry

297
Q

Osteoma

A

Benign, slow growing unilateral bone tumor

Can cause discomfort, otorrhea, conductive hearing disturbance

298
Q

Exostosis

A

Reactive growth of periosteum

Usually due to chronic cold water/wind exposure (surfer’s ear)

299
Q

Conductive hearing loss

A

Results from dysfunction of external or middle ear

Obstruction, mass loading, stiffness effect of ossicles, discontinuity

300
Q

Sensory hearing loss

A

Results from deterioration of the cochlea usually due to loss of hair cells from the organ of corti

301
Q

Neural hearing loss

A

Lesions involving eighth nerve, auditory nuclei, ascending tracts, auditory cortex

302
Q

Vestibular schwannoma

A

Intercranial tumor, unilateral, associated with neurofibromatosis type 2

303
Q

Acute otitis media

A

Results in accumulation of fluid and mucus which becomes infected by bacteria

304
Q

Acute otitis media clinical findings

A

Otalgia, aural pressure, decreased hearing, fever

Erythema, decreased mobility of the tympanic membrane

TM can rupture, otorrhea follows

Mastoid tenderness, presence of pus within the mastoid air cells

305
Q

Chronic otitis media

A

Pseudomonas

Purulent aural discharge, with perforation common

Pain is uncommon except during acute exacerbations

306
Q

Complications of otitis media

A

Petrous apicictis, sigmoid sinus thrombosis

307
Q

Cholesteatoma

A

Special variet of chronic otitis media, caused by prolonged Eustachian tube dysfunction

Squamous epithelium lined sac, fills with desquamated keratin and becomes chronically infected

308
Q

Eustachian tube dysfunction

A

Examination may reveal retraction of tympanic membrane and decreased mobility on pneumatic otoscope

309
Q

Serous otitis media

A

Prolonged Eustachian tube dysfunction and negative middle ear pressure may cause a transudate on of fluid

Usually accompanied by air bubbles in the middle ear and conductive hearing loss

310
Q

Myringotomy

A

Small eardrum perforation, provides immediate relief and is appropriate in the setting of severe otalgia and hearing loss

311
Q

Central retinal vein occlusion is at the level of…

A

The optic nerve

312
Q

Branch retinal vein occlusion is at the level of…

A

Any distal branch of the central vein

313
Q

Clinical findings of CRVO

A

Acute, painless vision loss, unilateral

Can be more subtle and incomplete, which suggests nonischemic type

314
Q

clinical findings of BRVO

A

May be asymptomatic with complaint of blurred vision, worsening over hours to days

315
Q

Vein occlusion physical signs and symptoms

A 
Decreased visual acuity
Dilated tortuous veins
Retinal hemorrhages (blood and thunder appearance)
Disk edema
Cotton wool spots
316
Q

Retinal artery occlusion

A

Painless loss of monocular vision, central or branch

Embolism of retinal artery, aka ocular stroke

**opthalmologic emergency!!

317
Q

What causes a cherry red spot at the macula?

A

Obstruction of blood flow to the retinal artery, but continued blood flow to the choroid from the ciliary artery

Would also cause a pale retina

318
Q

Complete vs. sectional vision loss for artery occlusions?

A

Complete vision loss suggests CRAO

Sectional vision loss suggests BRAO

319
Q

Physical exam and signs of artery occlusions

A

Ischemic edema, cherry red spot, boxcarring, pale fundus

320
Q

Describe amaurosis fugax

A

Transient loss of vision in one or both eyes, sudden onset that lasts a few seconds to a few minutes

Painless, precursor to artery occlusion

321
Q

Amaurosis fugax clinical findings

A

Usually monocular, “curtain or shade pulling down over the eye”, painless, transient vision loss, vision restored to normal after each episode

322
Q

Optic neuritis

A

Inflammation of the optic nerve, strongly associated with demyelinating disease (MS)

323
Q

Optic neuritis clinical findings

A

Hx of previous viral illness, unilateral loss of vision, usually over a few days, ocular pain, loss of color vision, vision loss exacerbated by heat or exercise

324
Q

Optic neuritis physical exam

A

Relative afferent pupillary defect (Marcus gunn pupil)

Central scotomata (can’t see center of vision)

325
Q

What is the Marcus gunn pupil?

A

Pupil dilates with direct light into the eye instead of constricting

326
Q

What are well tolerated FB on the cornea?

A

Inert objects, like paint, glass, plastic, or fiberglass

327
Q

Diagnosis for corneal foreign body

A

Fluorescein stain, slit lamp test, topical anesthetics

328
Q

Clinical findings and exam for corneal abrasion

A

Severe pain, FB sensation, tearing, photophobia

Fluorescein stain

329
Q

Subconjunctival hemorrhage

A

Bleeding from small vessels under the conjunctiva

Occurs spontaneously and resolves spontaneously

330
Q

Ocular chemical burns

A

EMERGENCY

Alkali burns- more severe
Copious irrigation!!

331
Q

Hyphema

A

Pooling of blood in the anterior chamber, usually from blunt trauma

Indicated significant ocular injury!!

332
Q

Seidel’s sign

A

Fluorescein streams like a waterfall from the iris, found in Hyphema/globe rupture

333
Q

Orbital floor fracture

A

Blowout fracture, significant consequence is entrapment of inferior reclusive muscle and/or orbital fat

334
Q

Globe rupture

A

Opthalmologic emergency

Full thickness corneal or scleral injury from trauma

Pain, severely decreased acuity, Hyphema, corneal laceration, irregular pupil, seidel’s sign

335
Q

Keratitis

A

Inflammation of the cornea, from direct exposure to UV light

336
Q

Clinical findings and treatment of keratitis

A

Bilateral eye pain, photophobia, tearing, FB sensation, acuity may be mildly diminished, may have diffuse corneal haze if severe

337
Q

Herpes keratitis

A

Dendritic lesion!

338
Q

Rhinitis is the presence of 1 or more of the following symptoms…

A

Sneezing
Rhinorrhea (anterior and or posterior)
Nasal congestion
Nasal itching

339
Q

Rhinosinusitus definition

A

Encompasses disorders affecting both the nasal passages and paranasal sinuses

340
Q

Allergic rhinitis general and pathophysiology

A

Can be seasonal or perennial, often seen with eczema or asthma patients

Airborn allergen, humoral and cytotoxic immune responses are activated

341
Q

Symptoms of allergic rhinitis

A

Nasal itching, watery rhinorrhea, congestion, sneezing

Fatigue, snoring, poor sleep

Ocular irritation, Pruritus, conjunctival erythema, excessive tearing

342
Q

Physical exam in allergic rhinitis

A

Nasal mucosa: pale, edematous, normal, nasal polyps

Allergic conjunctivitis
Allergic shiners
Allergic salute

343
Q

Non allergic rhinitis

A

Diagnosis of exclusion, perennial symptoms, examination is normal

344
Q

Acute viral rhinitis general

A

“Common cold”, self limited viral illness

345
Q

Acute viral rhinitis symptoms

A

Sore throat, cough, malaise, HA, fever, sneezing, rhinitis, nasal congestion and watery discharge

Minimal findings, may have erythematous and edematous nasal mucosa

346
Q

Rhinitis medicamentosa

A

Inflammatory rhinitis that leads to rebound nasal congestion, leading to dependence on causative agent

(Like OTC nasal decongestant sprays)

Swollen, beefy red nasal mucosa

347
Q

Acute rhinosinusitis General

A

Inflammation of nasal cavity and paranasal sinuses lasting

348
Q

Acute rhinosinusitis clinically

A

Nasal congestion and obstruction, purulent nasal discharge, maxillary tooth discomfort, facial pain and pressure, maybe fever, fatigue, cough, HA, etc.

Diffuse edema of nasal mucosa, narrowing of middle meat us, purulent discharge

349
Q

Chronic rhinosinusitis

A

Inflammatory condition involving paranasal sinuses and nasal mucosa lasting 12 WEEKS OR MORE

Must have at least 2 of the signs and symptoms, mucosal inflammation required

350
Q

Nasal polyps

A

Benign nasal tumors, usually from long standing inflammation of nasal and sinus cavities

Pale, edematous, mucosally covered masses

351
Q

What should you suspect in kids with nasal polyps?

A

cystic fibrosis

352
Q

What is samter’s triad?

A

Asthma
Nasal polyps
Aspirin, NSAID sensitivity

353
Q

Apthous ulcers

A

Aka canker sores, ulcerative stomatitis

Self limited, painful ulcerations

Small, round ulcerations with yellow gray centers with red halo surrounding

354
Q

Bacterial findings in pharyngitis

A

Tonsillar exudate, fever, lack of URI symptoms, anterior cervical lymphadenopathy

355
Q

Findings most suggestive of EBV (mono)

A

Classic triad: fever, pharyngitis, and marked lymphadenopathy

Fatigue, malaise, splenomegaly

356
Q

Peritonsillar abcess clinical findings

A

Sore throat, odynophagia, fever, deviation of uvula, hot potato voice, lock jaw

357
Q

Retro pharyngeal abscess

A

Spread of infection from sinuses, ear or Nasopharynx

Needs aggressive treatment

Dysphagia, drooling, strider, muffled voice, fever

Ludwig’s angina - tooth source

358
Q

Sialadenitis

A

Inflammation/infection of any salivary gland

Commonly from Sialolithiasis

359
Q

Sialadenitis clinical findings

A

Acute swelling of gland, increased with meals

Tenderness and erythema of duct opening, pus can be massaged out

360
Q

Dysphonia

A

Any disorder of phonation affecting the voice quality or ability to produce voice

361
Q

Stridor

A

High pitched, noisy respiration

Usually from respiration obstruction of trachea or larynx

362
Q

Laryngitis general

A

Inflammation, erythema, edema of larynx/vocal chords

Acute: usually viral, or voice overuse

Chronic: GERD, inhaled irritants

363
Q

Epiglottitis

A

Severe acute bacterial infection of epiglottis and supra glottis structures

LIFE THREATENING EMERGENCY

364
Q

Epiglottitis clinical findings

A

Abrupt onset of high fever, sore throat, dysphagia

Hot potato voice, drooling, sniffing or tripod position

Rapid progression of toxicity or respiratory distress

365
Q

Supraclavicular lymph nodes that are enlarged are…

A

Always abnormal

366
Q

Bronchial cleft cyst

A

Congenital lesion

Soft, cystic mass on anterior portion of sternocleidomastoid

367
Q

Thyroglossal duct cyst

A

Congenital abnormality

Midline neck mass, residual from thyroid

368
Q

Episcleritis

A

Inflammation of episclera

Abrupt onset, usually self limited

369
Q

Episcleritis clinical manifestations

A

Acute onset of ocular redness, irritation, watering

Pain is rare, vision is normal

*refer to ophthalmology

370
Q

Scleritis

A

Painful, destructive, and potentially blinding

Highly symptomatic- severe boring pain, tender to palpation, painful EOMs, diplopia, violaceous redness of eye

Ciliary flush

371
Q

Ciliary flush

A

Erythema goes right up to the iris, seen in scleritis

372
Q

Uveitis

A

Intra ocular inflammation, leukocytes

Hypopyon may be present (pus in anterior chamber)

373
Q

Anterior chamber uveitis

A

Iritis, presents with pain, ciliary flush, constricted pupil

Iris can adhere to cornea (posterior synechiae)

374
Q

Posterior chamber uveitis

A

Painless, with floaters and decreased visual acuity

375
Q

Cataracts

A

Opacification of the lens, usually protein clumping

Often bilateral, painless progressive decline in vision

376
Q

Cataracts treatment

A

Surgery if unable to perform ADLs or inability to monitor retinal/optic nerve or glaucoma

377
Q

Retinoblastoma

A

***be aware of this

Classically presents as leukocoria in a child less than two

378
Q

Leukocoria

A

White pupillary reflex

379
Q

Glaucoma

A

Optic neuropathy, usually increased intra ocular pressure

Cupping of optic disk, ocular hypertension

380
Q

Acute angle closure glaucoma

A

Narrowing or closure of anterior chamber angle

Risk factors: shallow angle, could be increased pupil dilation

381
Q

Acute angle closure glaucoma presentation

A

Severe pain, blurry/decreased vision, halos around lights, headache, nausea

Conjunctival injection, steamy cornea, sluggish response to light

382
Q

Iridotomy

A

Allows for decompression of anterior chamber, acute angle closure glaucoma

383
Q

Chronic glaucoma

A

Insidious onset, peripheral vision loss

Open angle or closed angle

Need two of three: cupping, visual field defects, increased intra ocular pressure

384
Q

Retinal detachment

A

Usually spontaneous, cloud like retina,

Typically starts inferior then spreads upward

Urgent ophthalmology referral, keep head tilted backwards

385
Q

Vitreous hemorrhage

A

Sudden vision loss with floaters

May see blood and hemorrhage in the eye

386
Q

Age related macular degeneration

A

Loss of central vision, progressive and usually bilateral

Can have hard or soft drusen and lipid deposits beneath the retina

387
Q

Atrophic “dry” age related macular degeneration

A

Hard drusen (Small, bright yellow), depigmentation of retina suggests atrophy

388
Q

Neovascular “wet” age related macular degeneration

A

Soft drusen, proliferation of new vessels, more rapidly progressive and severe

389
Q

Amsler grid

A

Useful in age related macular degeneration

Clin Med (7 decks)

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