Medicine & Pathology Flashcards
___, ___, ___, and rarely __-__ ____ can occur, most commonly with paroxetine, which tends to have stronger anticholinergic effects.
Dry eye, accommodative changes, mydriasis, and rarely angle-closure glaucoma can occur, most commonly with paroxetine, which tends to have stronger anticholinergic effects.
___ immunization is characterized by transfer of ___ from a host with active immunity to a susceptible host.
Passive immunization is characterized by transfer of immunoglobulin from a host with active immunity to a susceptible host.
___ immunization involves administration of ___ of an infectious agent to allow the host to develop an immune response.
Active immunization involves administration of weakened or inactivated components of an infectious agent to allow the host to develop an immune response.
Intramuscular injection of inactivated poliovirus; intranasal administration of live, attenuated influenza virus; and intramuscular injection of pneumococcal polysaccharide antigen are examples of active immunization.
To lower the patient’s LDL-C level by 50% with treatment, use a high dose of ___ or ___.
To lower the patient’s LDL-C level by 50% with treatment, use a high dose of rosuvastatin or atorvastatin..
___ or ___, ___ or ___, or rosuvastatin low dose or atorvastatin low dose are for low- or moderate-intensity therapy (to lower LDL-C by 30%).
Pravastatin or simvastatin, fluvastatin or lovastatin, or rosuvastatin low dose or atorvastatin low dose are for low- or moderate-intensity therapy (to lower LDL-C by 30%).
Aflibercept is a recombinant fusion protein that acts as a decoy receptor for vascular endothelial growth factor (VEGF), and inactivates VEGF-A, VEGF-B, and placental growth factor.
Aflibercept is a recombinant fusion protein that acts as a decoy receptor for vascular endothelial growth factor (VEGF), and inactivates VEGF-A, VEGF-B, and placental growth factor.
____ is a humanized monoclonal antibody directed against VEGF-A.
Bevacizumab is a humanized monoclonal antibody directed against VEGF-A.
___ is an aptamer that specifically binds the ___ __ ___ of VEGF.
Pegaptanib is an aptamer that specifically binds the human 165 isoform of VEGF.
____ is a recombinant humanized antibody fragment that binds __ ____ ____ of ___ .
Ranibizumab is a recombinant humanized antibody fragment that binds all active isoforms of VEGF-A.
Etanercept and infliximab have been associated with demyelinating disease and __ ___.
Etanercept and infliximab have been associated with demyelinating disease and optic neuritis.
The criteria for diagnosing metabolic syndrome include 3 or more of the following: a decreased high-density-lipoprotein cholesterol (HDL-C) level (< __ mg/dL for men, < __ mg/dL for women), increased abdominal obesity (US: > __-inch waist circumference for men, > __ inches for women), elevated triglyceride level (≥ ___ mg/dL), hypertension (blood pressure > __/__ mm Hg), and an elevated fasting glucose level (≥ __ mg/dL).
The criteria for diagnosing metabolic syndrome include 3 or more of the following: a decreased high-density-lipoprotein cholesterol (HDL-C) level (< 40 mg/dL for men, < 50 mg/dL for women), increased abdominal obesity (US: > 40-inch waist circumference for men, > 35 inches for women), elevated triglyceride level (≥ 150 mg/dL), hypertension (blood pressure > 130/85 mm Hg), and an elevated fasting glucose level (≥ 100 mg/dL).
__, __, and some __ __ blockers increase the risk of myopathy when taken in conjunction with simvastatin.
Gemfibrozil, amiodarone, and some calcium channel blockers increase the risk of myopathy when taken in conjunction with simvastatin.
Approximately what percentage of the normal population has an antinuclear antibody (ANA) titer > 1:40?
30%
Thiazide-type diuretics can cause __ vision, ___, ___ vision abnormalities, and ___ ___.
Thiazide-type diuretics can cause decreased vision, myopia, color vision abnormalities, and retinal edema.
Heparin works by inactivating ___, factor __, and factor __.
Heparin works by inactivating thrombin, factor Xa, and factor IXa.
Amantadine has been shown to cause bilateral, potentially reversible, ___ ___ decompensation in certain patients receiving long-term treatment (eg, multiple sclerosis, Parkinson disease).
Amantadine has been shown to cause bilateral, potentially reversible, corneal endothelial decompensation in certain patients receiving long-term treatment (eg, multiple sclerosis, Parkinson disease).
Large vessel vasculitides include ___ __ ___ and ___ ___.
Large vessel vasculitides include giant cell arteritis and Takayasu arteritis.
___ ___ and ___ ___ are examples of medium-size vessel vasculitis.
Polyarteritis nodosa and Kawasaki disease are examples of medium-size vessel vasculitis.
Granulomatosis with polyangiitis affects ___ blood vessels.
Granulomatosis with polyangiitis affects small blood vessels.
Behçet disease affects __ ____ of blood vessels.
Behçet disease affects all sizes of blood vessels.
Nearly all strains of H influenzae are resistant to ___. The most current recommendation for empiric treatment of H influenzae are __-generation ___.
Nearly all strains of H influenzae are resistant to macrolides. The most current recommendation for empiric treatment of H influenzae are third- generation cephalosporins.
Growth involving the angle and trabecular meshwork up to - clock hours may be an indication for excision. Iris melanomas are classified using the modified ___ classification. Most are ___ cell melanomas, compared to the mixed cell type, which is most common in choroidal melanomas.
Growth involving the angle and trabecular meshwork up to 3 to 4 clock hours may be an indication for excision. Iris melanomas are classified using the modified Callender classification. Most are spindle cell melanomas, compared to the mixed cell type, which is most common in choroidal melanomas.
Callender classification: what is it used for? What do the results mean for prognosis?
Used to classify ocular melanoma. Spindle cells have best prognosis, epithelioid cells have worst prognosis
Polymorphisms in the LOXL1
gene are associated with PXF. Lysyl oxidase is a pivotal enzyme in ___ ___ formation, catalyzing covalent crosslinking of collagen and elastin.
Polymorphisms in the LOXL1
gene are associated with PXF. Lysyl oxidase is a pivotal enzyme in extracellular matrix formation, catalyzing covalent crosslinking of collagen and elastin.
Gene mutations associated with Axenfeld-Rieger syndrome
FOXC1, PITX2
Gene mutations associated with aniridia and Peters anomaly
PAX6
Used to stain neuroectoderm, e.g. retina, optic nerve, schwannomas, neurofibromas, melanocytes
S-100
Used to stain melanocytes and melanocytic lesions, e.g. nevi, PAM, melanoma, but NOT neuroectoderm (2)
HMB-45 and Melan-A
Used to stain lesions with smooth or skeletal muscle features, e.g. leiomyoma, rhabdomyosarcoma (3)
actin, desmin, myoglobin
In rare instances, intraocular calcifications can be seen in toxocariasis, PFV, and Coats. In these cases, calcifications are usually __ and ___…
In rare instances, intraocular calcifications can be seen in toxocariasis, PFV, and Coats. In these cases, calcifications are usually focal and discrete, occurring within granulomas (toxocariasis) or a retrolental membrane (persistent fetal vasculature) or at the level of the RPE (Coats disease).
It is generally accepted that performing temporal artery biopsy within _ ___ of starting steroid therapy will not compromise the histopathological diagnosis.
It is generally accepted that performing temporal artery biopsy within 1 week of starting steroid therapy will not compromise the histopathological diagnosis.
Flow cytometry may be performed on ___, ___, or ___ ___ tissue specimens. Cells analyzed by flow cytometry must be sent as ___ specimens.
Flow cytometry may be performed on vitreous, aqueous, or ocular adnexal tissue specimens. Cells analyzed by flow cytometry must be sent as fresh (unfixed) specimens.
Nanophthalmos is a rare disorder characterized by a ___ axial length (- mm), a normal or slightly ___ lens, and ___ sclera. Nanophthalmic eyes are predisposed to ___ ___ and ___.
Nanophthalmos is a rare disorder characterized by a short axial length (15–20 mm), a normal or slightly enlarged lens, and thickened sclera. Nanophthalmic eyes are predisposed to uveal effusion and glaucoma.
Separation of ciliary body from scleral spur
Cyclodialysis cleft
Disinsertion of the iris root
Iridodialysis
Tear between the circular and longitudinal fibers of the ciliary body
Angle recession
Tear of the trabecular meshwork
Trabecular cleft (seen on gonioscopy)
Epithelial cells infected with herpesvirus might display ___ ___.
Epithelial cells infected with herpesvirus might display intranuclear inclusions.
Gene mutations found in nevi of Ota, blue nevi, and uveal melanoma?
GNAQ
(BAP1 found ONLY in uveal melanoma, BRAF in cutaneous melanomas)
***GNAQ does NOT correlate with prognosis, unlike BAP1, which heralds high risk of metastasis
___ ___ retinoblastoma is typically found in older children (>5), is unilateral, and is nonhereditary, and often presents with conjunctival injection, ___, and large clumps of ___ ___. The typical calcification on ultrasonography or computed tomography (CT) imaging can be absent.
Diffuse infiltrating retinoblastoma is typically found in older children (>5), is unilateral, and is nonhereditary, and often presents with conjunctival injection, pseudohypopyon, and large clumps of vitreous cells. The typical calcification on ultrasonography or computed tomography (CT) imaging can be absent.
___ growth pattern of retinoblastoma describes growth on the retinal surface into the vitreous cavity and would present with visible tumor mass.
Endophytic growth pattern of retinoblastoma describes growth on the retinal surface into the vitreous cavity and would present with visible tumor mass. (but can also present with tumor seeding into the anterior chamber and vitreous cells)
___ growth of retinoblastoma describes growth underneath the retina, and often presents with serous retinal detachment.
Exophytic growth of retinoblastoma describes growth underneath the retina, and often presents with serous retinal detachment.
___ ___ ___ can have several presentations, including a painless, slow-growing, firm nodule of the conjunctiva; chronic unilateral conjunctivitis/blepharitis; and eyelid thickening and deformity, with focal loss of eyelashes.
Sebaceous gland carcinoma can have several presentations, including a painless, slow-growing, firm nodule of the conjunctiva; chronic unilateral conjunctivitis/blepharitis; and eyelid thickening and deformity, with focal loss of eyelashes.
Capillary hemangioma of the eyelid is an example of what?
Hamartoma
Tumor made of tissue derived from all 3 embryonic germ layers
Teratoma
Malignant soft tissue tumor
Sarcoma
Germinative zone of lens
Pre-equatorial
Made of cuboidal epithelial cells
Bow region of lens
Post-equatorial
Epithelial cells complete differentiation and lose organelles
Risk factors for OSSN
HIV, HPV, older age, smoking, UV light exposure
Gene mutation associated with orbital rhabdomyosarcoma
FOXO1
Zones of Descemet membrane
Anterior banded zone (present at birth)
Posterior nonbanded zone (grows throughout life)
Condition characterized by infiltration of uveal tract by benign nevoid or spindle-shaped cells
Bilateral diffuse uveal melanocytic proliferation (BDUMP)
Normal depth of the AC
3.0-3.5 mm
Frozen sections are generally not recommended on ___ lesions because of the potential for artifact.
Frozen sections are generally not recommended on melanocytic lesions because of the potential for artifact.
The primary treatment of choice for symptomatic circumscribed choroidal hemangioma is ___ ___. ___ ___ ___ is used for treating diffuse choroidal hemangiomas.
The primary treatment of choice for symptomatic circumscribed choroidal hemangioma is photodynamic therapy (PDT). External beam radiotherapy is used for treating diffuse choroidal hemangiomas.
Medium for immunofluorescence studies
Michel or Zeus medium
Fixative for electron microscopy
Glutaraldehyde
___ are involved with support and nutrition. Macrophages of the CNS, or ___ ___, have phagocytic function and would engulf hemosiderin after a CNS or retinal hemorrhage.
Astrocytes are involved with support and nutrition. Macrophages of the CNS, or microglial cells, have phagocytic function and would engulf hemosiderin after a CNS or retinal hemorrhage.
Gene mutation associated with congenital aphakia, sclerocornea, microphthalmia, disc coloboma
FOXE3 (homozygous)
Gene mutation associated with Alport syndrome
COL4A
Used as stain for carcinoma
Cytokeratin
__ __ __ or __ __ __, can be used to diagnose sebaceous carcinomas because they reveal lipid within the cytoplasm of tumor cells.
Oil red O or Sudan black B, can be used to diagnose sebaceous carcinomas because they reveal lipid within the cytoplasm of tumor cells.
Aniridia is associated with __, corneal __, and __ __.
Aniridia is associated with cataract, corneal pannus, and foveal hypoplasia.
Differential of chronic cicatrizing conjunctivitis
Immune blistering disease (MMP)
Previous trauma/chemical injury
Previous severe infection (adenovirus, trachoma)
Neoplasm
Most patients with ___ ___ lymphoma will develop central nervous system (CNS) involvement. Conversely, of patients who present with CNS involvement, approximately __% will have intraocular involvement.
Most patients with primary vitreoretinal lymphoma will develop central nervous system (CNS) involvement. Conversely, of patients who present with CNS involvement, approximately 20% will have intraocular involvement.
___ lymphoma is usually more indolent and is associated with systemic lymphoma in up to __ of cases. Evaluation for systemic involvement includes use of __ or combined __ and __ imaging of the thorax, abdomen, and pelvis.
Uveal lymphoma is usually more indolent and is associated with systemic lymphoma in up to one-third of cases. Evaluation for systemic involvement includes use of computed tomography (CT) or combined CT and positron emission tomography (PET) imaging of the thorax, abdomen, and pelvis.
Histologic study of RPE changes in Gardner syndrome reveals that they are more consistent with ___ of the RPE than with ___. The RPE changes in Gardner syndrome are probably more appropriately termed ___.
Histologic study of RPE changes in Gardner syndrome reveals that they are more consistent with hyperplasia of the RPE than with hypertrophy. The RPE changes in Gardner syndrome are probably more appropriately termed hamartomas, consistent with the loss of regulatory control of cell growth that results in other soft-tissue lesions in this syndrome.
How does a Fuchs adenoma present? What does it represent?
At autopsy; glistening, white or tan, irregular tumor arising from the pars plicata
Benign proliferation of nonpigmented ciliary epithelium with accumulated basement membrane
What determines iris color?
Melanin granules in anterior stromal melanocytes
Causes of interstitial keratitis
HSV Mycobacterium TB/leprae Borrelia burgdorferi EBV Treponema pallidum
The ___ giant cell can be distinguished by the presence of several nuclei in a distinct pattern: a ring of nuclei surrounds a central homogeneous, eosinophilic cytoplasm; and ___ cytoplasm surrounds the nuclei.
The Touton giant cell can be distinguished by the presence of several nuclei in a distinct pattern: a ring of nuclei surrounds a central homogeneous, eosinophilic cytoplasm; and foamy cytoplasm surrounds the nuclei. Touton giant cells are seen in lesions with high lipid content, such as fat necrosis, xanthomas, and xanthogranulomas.
What cells make up posterior synechiae?
Pigmented epithelial cells of the iris (migrate over lens capsule and adhere to lens epithelial cells)
How are VKH and SO distinguished?
History of trauma or intraocular surgery
Sparing of the choriocapillaris
Human papillomavirus (HPV) __ and __ have been associated with CIN, as well as sessile papillomas, whereas HPV __ and __ have been associated with pedunculated papillomas.
Human papillomavirus (HPV) 16 and 18 have been associated with CIN, as well as sessile papillomas, whereas HPV 6 and 11 have been associated with pedunculated papillomas.
__%-__% of patients with periocular lymphomas have previous or concomitant systemic disease, and __% develop it over 5 years. The risk is lowest for ___ lesions, greater for ___ lesions and highest for ___ lesions.
20%-30% of patients with periocular lymphomas have previous or concomitant systemic disease, and 30% develop it over 5 years. The risk is lowest for conjunctival lesions, greater for orbital lesions and highest for eyelid lesions.
Used to stain calcium (2)
Alizarin red
von Kossa
Vogt triad
Tuberous sclerosis: adenoma sebaceum, mental deficiency, seizures
How is the optic cup created?
Neural plate folds to form neural tube
2 optic pits form from invagination of neural tube
Optic pits deepen to form optic vesicles
Optic vesicles invaginate to create 2-layered optic cup
What tissues does the optic cup create (inner and outer layer)?
Inner = retina Outer = RPE
What forms the neural crest cells?
Cells at apex of neural plate after it folds
How is the lens vesicle created?
As optic vesicle forms, focal thickening occurs where it approaches outer wall of embryo (lens placode)
Lens placode invaginates to form lens vesicle
Biopsies that should be performed when suspecting sebaceous adenocarcinoma (2)
Full-thickness excisional eyelid biopsy
Conjunctival map biopsy
What are the 2 classification systems for RB? Compare and contrast them.
Reese-Ellsworth classification: group I-V (favorable) based on probability of eye preservation when treated with EBR; includes tumor number, size, and location, and vitreous seeding
International classification for intraocular RB: class A-E based on eye’s response to chemotherapy; includes tumor size, SRF, vitreous and subretinal seeding
When should you consider enucleation instead of intraarterial chemotherapy for RB?
Class E (International classification) Unilateral disease
What is the chance of a patient with bilateral RB having a child with RB?
45% (50% chance of inheriting the abnormal RB1 allele and 90% chance of penetrance/mutating second allele)
What percentage of RB is inherited and what percentage sporadic?
10% have family history, 90% are sporadic
What percentage of sporadic RB is attributed to germline mutations?
40% (remaining 60% are somatic mutations with unilateral disease)
What systemic condition is associated with RPE hamartomas?
Colorectal carcinoma
Pathology of combined hamartoma of retinal pigment epithelium and retina will show what finding?
Dysplastic glia, proliferating RPE cells
Normal timeframe after corneal abrasion for epithelial anchoring fibrils to reform
4-6 weeks
What type of tissue adaptation occurs within orbicularis oculi and EOM in response to injury?
Hypertrophy (terminal cells so do not regenerate)
Histologic findings that suggest higher risk of hematogenous spread of RB
Massive choroidal invasion
Findings associated with higher risk of metastasis in RB (4)
Optic nerve invasion (to CNS; most common route of metastasis)
Massive choroidal invasion (hematogenous)
Direct extraocular extension
Anterior chamber involvement
Most common initial therapy for ciliary body medulloepithelioma
Enucleation (presents in advanced/large state)
If caught earlier, can do cryo, local resection, plaque or external beam radiation
Ultrasound finding suggestive of melanoma
Low internal reflectivity
Ultrasound finding suggestive of choroidal osteoma
Acoustic shadowing
Most common epithelial tumor of lacrimal gland
Pleomorphic adenoma
What layer of cornea, when incompletely healed, may allow for fibrous ingrowth?
Descemet membrane
What tissue response occurs within the lens epithelium after anoxic or hypoxic injury, such as posterior synechiae or markedly elevated IOP?
Metaplasia
Most important test to obtain in patient with primary vitreoretinal lymphoma
MRI brain and orbits
Most common clinical presentation of primary intraocular lymphoma
Vitritis
Pathology of peripheral nerve tumors in NF1
AKA neurilemomas, or Schwannomas
Antoni A spindle cells: collections of interlacing cords, whorls, palisades that form Verocay bodies (collections of fibrils)
Antoni B spindle cells: stellate cells with mucoid stroma
Pathology of optic nerve gliomas
Rosenthal fibres: degenerating cell processes that appear as enlarged, deeply eosinophilic filaments
Pathology of meningiomas
Psammoma bodies
