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Oral boards > Friedman external dz/adnexa > Flashcards

Friedman external dz/adnexa Flashcards

1
Q

Lid lesion DDx

A 
squamous cell carcinoma  (or SCC variant - keratoacanthoma)
BCC
Sebaceous cell carcinoma
inflamed actinic keratosis
tricholemmoma
Merkel cell tumor
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2
Q

Merkel cell tumor

A

Merkel cell carcinoma Highly malignant with frequent metastases at presentation Fast-growing, violaceous,

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3
Q

Keratoacnthoma Rx

A

complete excision of lesion

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4
Q

Sebaceous cell carcinoma Rx

A

wide excsiion with frozen section and conjunctival map Bx

Exenteration - performed for orbital extension or pagetoid spread
XRT for palliation

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5
Q

Scleritis DDx

A 
Systemic assoc (50%)
30% have collagen vascular dz - RA, ankylosing spondylitis, SLE, polyarteritis nodosa, Wegener's, relapsing polychondritis

Other etiologies - herpes zoster, syphilis, TB, leprosy, gout, porphyria, idiopathic

Work-up: CBC with diff, RF/anti-CCP, ANA, ANCA, VDRL/RPR, FTA-ABS, PPD, CXR

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6
Q

what dz causes anterior necrotizing scleritis w/o inflammation (scleromalacia perforans)?

A

RA

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7
Q

signs of posterior scleritis

A 
chorioretinal folds
serous RD
vitritis
ON edema
"T" sign - thickened sclera on B-scan U/S
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8
Q

Conjunctival lesion DDx and next step

A 
CIN (atypical cells confined to the epithelium w/o penetration of BM often @ limbus, usually no KNV)
lymphoid lesion
pterygium/pinguecula
papilloma
squamous cell carcinoma

Excisional Bx

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9
Q

Rx for squamous cell carcinoma

A

Treatment?
Excision with 4mm margins & thin scleral flap
Treat base with alcohol
Treat margins with cryo
Topical interferon, MMC, 5-FU gtts if large

Gelatinous lesion
Location?
Interpalpebral zone near limbus

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10
Q

Most common conjunctival tumor?

A

Squamous cell carcinoma

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11
Q

Most common eyelid tumor?

A

Basal cell carcinoma

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12
Q

Name medications that cause conjunctivitis?

A

Propine, Iopidine, Alphagan, Neomycin

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13
Q

Conjunctival Squamous Papilloma - location and demographics, pathology

A

Location
Children?
fornix, multiple, pedunculated

Adults?
limbus, single, sessile

Viral association?
Children: HPV 6 & 11
Adults: HPV 16 & 18

Pathology?
Papillary fibrovascular fronds
Must excise in adults to differentiate from CIN
May recur in multiple sites

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14
Q

Oncocytoma

A 
Metaplasia of ductal & acinar cells of accessory lacrimal glands
Usu. pink lesion on caruncle
Pathology:
Large eosinophilic cells
Glandular spaces
Numerous mitochondria
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15
Q

Pyogenic Granuloma

A

Fibrovascular tissue growth usu. over chalazion or conj surface surgery
Usu. fleshy lesion on palpebral conjunctiva
Pathology:
Small-caliber vasculature
Collagen stroma

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16
Q

Entropion evaluation and types

A 
lid tone (snapback test)
lower lid margin position (sagging)

cicatricial: scar excision with possible anterior lamellar resection/recession, tarsal fracture/graft or conjunctival/mucous membrane grafts
involutional: thermal cautery, quickert suture, horizontal or vertical lid shortening, lid

spastic -thermal cautery, botox injection, quickert suture, horizontal or vertical lid shortening, lid

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17
Q

Follicular conjunctivitis DDx

A

virus (adenovirus, HSV)
chlamydia
molluscum
drug rxn

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18
Q

True membrane conjunctivitis

A

strep
gonoccocus
croneybacterium
chemical burns

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19
Q

conjunctivitis questions

A

H/o URI, anyone with eye infection?
CL?
had a sTD in past?

20
Q

conjunctivitis exam

A 
preauricular lymphadenopathy
eyelid lesions
pseudomembrane on inferior tarsal conjunctiva
subconj hemorrhage
SEI in cornea
21
Q

chlamydia conjunctivitis path and Rx

A

path: basophilic cytoplasmic inclusion in epithelial cells

systemic and topical Abx with tetracycline or erythromycin
Rx all sexual partners

22
Q

Interstitial keratitis DDx

A 
Diffuse infiltrate with thickened stroma
Regression leaves ghost vessels
Causes?
Syphilis (most common cause if bilateral)
Herpes simplex, herpes zoster
Tuberculosis, leprosy

Other casues: mumps, rubella, lepropsy, onchocerciasis, sarcoidosis, Cogan’s

23
Q

Interstitial keratitis Treatment?

A

Treatment? topical steroids

24
Q

Cogan’s syndrome?

A

Interstitial keratitis with hearing loss
Meniere’s like vestibular dysfunction
Associated with URI
Treatment? systemic steroids

25
Q

congenital syphilis findings

A 
optic nerve atrophy
salt and pepper fundus
deafness
notched teeth
saddle nose
sabre shins
26
Q

Acute dacryoadenitis

A

infection 2/2 staph, mumps, EBV, VZV, N. Gonorrhea

Cx/gram stain of D/c - CBC with diff +/- blood Cx

27
Q

lacrimal gland tumors

A

50% lyphoproliferative or 50% epithelial
>50% epithelial tumors are pleomorphic adenomas (benign mixed tumor) and 50% malignant (adenoid cystica carcinoma and malignant mixed tumros)

28
Q

lacrimal gland Rx (benign)

A

Complete en bloc excision w/o Bx 2/2 rupture of pseudocapsule can result in recurrence and malignant transformation.

29
Q

Basal Cell Carcinoma location and pathology

A

Most common eyelid malignancy
More common on?
Lower lid > medial canthus (worst Px 2/2 invasion of lacrimal drainage system)> upper lid > lateral canthus

Pathology?
Basal cell nests
Peripheral palisades

30
Q

Basal Cell Carcinoma - two forms and Rx

A

Two forms?
Nodular
Most common
Firm, raised, pearly

Morpheaform
Much more aggressive
Firm, flat with indistinct borders
Slender tendrils. pagetoid spread

Treatment?
Excision w/ Mohs’ surgery
Rarely metastasize

31
Q

Sebaceous Carcinoma

A

Mimics chronic blepharitis or recurrent chalazion
More common in upper lid where there are more meibomian glands

Pathology?
Foamy cytoplasm
Pagetoid spread (intraepidermal spread of clusters of tumor cells)
“skip lesions”

Special stain?
Oil red O stains lipid in cytoplasm (must be fresh/frozen, as paraffin embedding destroys lipids)
Highly malignant

32
Q

Muir-Torre Syndrome?

A

Multiple sebaceous neoplasms
Keratoacanthosis
Visceral tumors (colon CA most common)
Inheritance: AD

33
Q

Symblepharon DDx

A 
chemical burn
S-J syndrome
OCP
trachoma
herpes zoster
atopic keratoconjunctivis
scleroderma
GVH disease
34
Q

chemical injury grading

A

based on severity of cornea damage and ischemia

35
Q

Stevens Johnson Syndrome

A

Erythema multiforme major
Type III immune hypersensitvity
Usu. in young patients
Caused by drugs (esp. antibiotics - sulfa, pencillin) or infection (mycoplasma, HSV, adenovirus, strep)

Signs:
Pseudomembranous conjunctivitis, symblepharon, trichiasis, severe dry eyes, corneal scarring/vascularization

Treatment:
Amniotic membrane, IV steroids
Topical abx, lubrication, symblepharon lysis

36
Q

Mooren ulcer - Demographic/Signs

A 
Idiopathic (?autoimmune)
Inflammatory peripheral thinning
Starts peripherally with leading undermined edge progressing circumferentially then centrally
Painful; epithelium missing
Perforation with minor trauma
37
Q

Mooren ulcer - types and treatment

A

2 types:
1: unilateral, older pts, slow progression
2: bilateral, West African males, rapid progression, most w/ coexisting parasitemia
Treatment:
excision of adjacent conjunctiva (lots of immune cells), steroids, CL, immunosuppressants

38
Q

Terrien Marginal Degeneration

A 
Idiopathic
Noninflammatory peripheral thinning
Begins superiorly, slowly spreads circumferentially; with pannus
Painless; epithelium intact
Perforation rare
High ATR astigmatism
2nd/3rd decade, progressive

Similar form in childhood:
Fuchs superficial marginal keratitis

39
Q

How to differentiate Mooren from PUK?

A

Usu. autoimmune dx (e.g. RA) in PUK
PUK involves sclera
Treatment: underlying disease

40
Q

Reis-Buckler dystrophy

A

Honeycomb opacification of central cornea
Painful erosions

Inheritance? AD (Ch 5; BIGH3/TGFB1)
Gene product? keratoepithelin

Pathology?
Bowman’s layer absent and replaced by thickened, “sawtooth” fibrocellular tissue

EM shows?
Rod-shaped bodies

41
Q

Thiel-Behnke dystrophy

A

Reis-Buckler type II
Honeycomb opacification of central cornea

EM shows?
Curly fibers

42
Q

Meesmann Dystrophy

A 
Inheritance? AD
Onset in 1st decade
Bilateral
Often asymptomatic; erosions rare
Pathology?
Epithelial cells contain peculiar substance (PAS+ material) and epitheliail basement membrane is thickened
43
Q

Marginal keratolysis work-up

A 
CBC with diff
RF/anti-CCP
ANA
ANCA
UA
44
Q

Primary acquired melanosis

A

Proliferation of melanocytes (pre=cancerous)
No cysts (unlike nevus)
may grown and involve cornea
Usually middle-age to elderly white people
If PAM + atypia, 46% risk for conjunctival melanoma

45
Q

Malignant melanoma

A

55% from PAM, 25% from nevus, 20% de novo
Pagetoid spread
May be amelanotic
Treatment: “no touch” excision, freeze-thaw cryo to margins, alcohol to base
Worse prognosis if?
Caruncle, fornix, palpebral conj
But better prognosis than cutaneous melanoma

46
Q

Keratoconus Dx

A

1) Central cornea power > 47.2
2) difference in cornea power between fellow eyes > 0.92 D
3) I-S value (difference between average inferior and superior cornea powers 3 mm from the center of the cornea): >1.4 D

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