Test 1 Flashcards
Acromegaly
pituitary gland disorder. inc cartilage growth. protrusion of jaw and enlargement of forehead. classical sign is bitemporal hemianopia
rickets
vitamin d deficiency. develop box like head
paget’s bone dz
painful redistribution of bone. enlarged skull and square jaw. more common in elderly, inc IOP. angioid streaks, retinal neov
alopecia
rapid onset loss of hair. rare. autoimmune rxn. secondary to toxic conditions most common
alopecia areata
a small to med patch of hair loss
alopecia areata totalis
condition of total hair loss
trichotillomania
neurotic condition that causes individuals to pull of their hair. most common in children and adolescents
tinea capitis
caused by ringworm-fungus. “black-dot” appearance. mild to moderate scaling with or without inflamm and pustules
sqamous cell carcinoma
from sun exposure. slow growing. can spread
contact dermatitis
nickel dermatitis. from cheap jewelry and zyl frames. generic name applied to acute inflamm reactions. allergen elicits a type IV (delayed) hypersens rxn. toxic irritant rxn and true allergic rxn.
auricular tophi
in gout. uric acid deposits along ear
polychondritis
inflamm of the cartilage. red and leathery appearance of the ear. can affect all cartilage esp the trachea
heriditary benign telangiectasia
little fan like patterns of new vessels on ear
Cushing’s moon face
linked to inc adrenal hormone or exogenous steroid use. round face w/ red cheeks. hirutism (facial hair in females). acne. inc fat tissue around face and trunk. extremities of normal caliber.
hirutism
excessive facial hair growth in females. need to rule out polycystic ovary syndrome-can become cancerous.
nephrotic syndrome
linked to kidney dz. edematous and pale face. swelling 1st appears around eyes on awakening. can become severe. swelling around ankles later in the day. will have pitting edema. renal failure.
florid myxedema
linked to hypothyroidism. dull puffy face. swelling around eyes. no pitting edema. skin is dry and thickened. hair and eyebrows are dry, coarse, and thinned.
parotid enlargement
can be chronic or acute. usually bilateral but not symmetrical. swelling is anterior to ear lobes and about the angle of the jaw. chronic assoc w/ obesity, cirrhosis, and Sjogren’s
Parkinson’s
mask like face with dec blinking. classic stare with chin down and eyes peering upward. skin slightly oily with blepheritis. neck and upper body flexed forward.
Bell’s Palsy
unilateral facial paralysis of sudden onset involving CN VI. ususally viral etiology. affects both upper and lower face. no other neuro findings. good prognosis.
upper motor neuron defect
CVA, or tumor. affects the lower face, so pts can lift both brows and wrinkle forehead. pos for other neuro signs. prognosis is guarded.
impetigo, bacterial-staph
infectious. preschool and young adults. vesicle, red based with honey colored crust (scab). sx: none to mild. slow spread, onset days to wks. scars rare. contagious. tx oral Abs
erysipelas
infectious bacterial. form of superficial/interstitial cellulitis, strep, or staph. spreading infection of subcutaneous tissue. mostly older adults, diabetics, obesity. tender to painful. red, sharply demarcated, warm, swollen. sx: malaise, fever. more common in men. prompt tx oral Abs
perioral dermatitis
infectious bacterial. onset between 15-40 yo, most common young women. small multiple acneiform papules, scaling. from over use of topical creams. sx: mildly pruritic, tx: oral Ab
herpes simplex (HSV)
infectious viral: aka: “cold sores, fever blisters”. reactivation of virus. stress common trigger, common in all ages and sex. sx: prodrome, pain, burning. lip most common site. vesicle rash, in phase to crusting lasting 2-6 wks. tx: oral acyclovir. risk of ocular involvement (will scar)
herpes zoster (HZV or VZV)
infectious viral. aka “shingles”. reactivation of chicken pox virus (varicella). stress common trigger. sx: prodrome, pain, burning. rash out of phase, vesicle, open to crusting lasting 10 dys. full resolution 4-5 wks. risk of oc involvement w/ CN V involvement (Hutchinson’s sign-nose). tx: oral acyclovir. contagious.
tinea corpuris
infectious fungal. aka “ringworm”. more common in children. circular or oval rash w/ a raised red border and a clearing scaly central area. sx: mildly pruritic. tx: oral antifungals. can be chronic and long term.
molluscum contagiosum
infectious viral. superficial poxvirus infection by direct contact. common in young children, young adults, and HIV pts. waxy or pearly, 1-3 mm, grouped umbilicated papules. face and eyelid. asympt. to mild itch. full resolution 4-8 wks. tx: freezing or curettage. center contains a yellow “cheesy” material when active.
milia cysts
epidermal cysts containing keratin. any age group. face and eyelids common. white to yellow, 1-2mm, grouped papules. assoc w/ trauma (ie constant rubbing). asympt. tx: excised. no umbilicated papules
acne vulgarus(common)
metabolic dermatitis. common in teens and young women. lighter skin types and strong FHx. hormone linked. signs: comedones, papules and papulopustules. risk of scars. tx mild: topical benzoyl peroxide and retinoids w/ topical or oral clindamycin or erythromycin.
cystic acne
metabolic dermatitis. males>females. age 10-20 yo. hx of same in parents. assoc w/ PCOS and XYY syndrome. signs: recurrent inflamm nodules and active scarring. tx: accutane.
vitiligo vulgaris
pigmentary disorder. idiopathic, acquired, circumscribed hypomelanosis. assoc. w/ autoimmune disorders. asympt, slow progression. non scaling or inflammatory. tx; skin bleaching agents, cosmetics. DDx tinea, SLE, and rosacea
melasma
pigmentary disorder. flat pigmentary darkening/deposit of the facial skin. assoc w/ pregnancy and BCP. common forehead and malar surfaces. will fade after term or d/c or meds (up to 2 yrs). tx: skin bleaching agents. DDx: SLE and Rosacea
Rosacea
metabolic dermatitis. common adults 30-50 yo). only on face.papules, pustules and telangiectasias. malar surfaces. dry eye dz. triggered by spicy foods, alcohol, stress and UV. can be caused by over use of topical steroids. tx: oral TCN or topical metronidazole (expensive).
telangiectasias
permanent dilation of preexisting capillaries and arterioles. net or fan like pattern from a focal point/lesion. blanches w/ pressure. assoc w/ hereditary colon dz, rheumatologic dz, and Rosacea depending on location.
spider nevus/ spider angioma
type of hemangioma. type of telaniectasia with capillaries radiating from a central arteriole. pressure on central arteriole blanches. more common in children, pregnancy, and BCP use. more common on face then trunk. can be assoc w/ elevated estrogen and liver dz.
systemic lupus erythematosus (SLE)
aka “lupus”. rheumatologic eczema(inflamm). non pustular scaling rash over the malar surfaces. no telangiectasias. constant.
psoriasis
metabolic eczema. 2% pop, heredity common. symmetrical areas. elbows, knees, scalp. 20% nail dz “pitting”. nail dz assoc w/ uveitis. constant for life.
seborrhea
metabolic dermatitis. common chronic scaling inflamm, seb glands. hypersensitivity to yeast, white to yellow oily scale. common in children and >30 yo. face, beard, eyebrows, lids (bleph), and scalp. more common in men. common in Parkinson’s and AIDS. tx: dandruff shampoos, lid scrubs, topical antifungal and steroid creams. no easy tx.
atopic dermatitis
metabolic dermatitis. is actually an eczema (pruritic inflamm). etiology unknown, genetic. males>. 35% develop asthma later in life. sx: symmetrical itchy dermatitis. face (lids), neck, lower arms, behind knees and toes. inc freq of allergies (IgE). remission>40%. dark circles under eyes and bright red cheeks.infraorbital fold: “dennie-mogan syndrome”. assoc w/ subcapular cataracts. most common OD visit is superior lid dermatitis. refer to dermatologist.
contact dermatitis: toxic irritant
toxic irritants: nickel, soaps, plants, etc. rxn: redness-blistering-erosion-crusting-shedding and scaling. sharp margins. tx: remove irritant, wet dressing, for exudative, topical steriods prn. heals 1-2 wks after removal of irritant.
contact dermatitis: allergic type
most common poison ivy then neomycin. poison ivy: delayed hypersens 8hrs-21dys. rxn: redness-vesicles-bullae-erosion-seepage-crusting-shedding and scaling. no scarring. must of had contact w/ resin, seepage will not spread.
seborrheic keratosis
neoplasm. benign epithelial tumor. “stuck on” appearance. onset rare before 30 yo, m>f. early flat “tan macule” later verrucous (rough) papules/plaques. few to hundreds. face trunk and arms. tx: cryosurgery. well circumscribed crusty lesion
actinic keratosis
pecancerous cutaneous epithelial lesion. onset middle age, m>f. sun exposed area, 1-3mm, rough scaly. risk squamous cell CA. forehead, cheeks, nose, hands and arms. many spontaneous remission. tx: cryosurgery
basal cell carcinoma
most common cancerous skin lesion. onset >40yo, m>f, genetic. sun exposed areas, lighter skin types. frequent invasion but metastases rare. slow growing. hard nodule with telangiectatic vessels over the margin, pearly rolled edge, central ulceration, bleeds. tx: cryosurgery and excision. 95% cure rate. typical location: lower lid near medial canthus
sebaceous hyperplasia
look like elevated basal cells, often confused. common. onset >40yo, m>f, genetic. soft yellow papules, 1-3mm raised donut shaped. forehead and cheeks, sun exposed areas. will have a central pore. tx: electrocautery
squamous cell carcinoma
2nd most common cancerous skin lesion. onset >55, m>f, genetic. lighter skin types, sun exposed. slow growing, frequent invasion, metastases possible. hard nodule, adherent scale. asympt. will ulcerate and bleed. tx: excision w/ radiation. 90% 5-yr rate.
nevus
benign skin tumors of nevus cells. anywhere. sun exposed areas. most common avg # 15-40, AA 2-11. brown to flesh color. macule (flat) to papule (raised). risk of coverting to dyplastic nevus. appears before age 30. light to dark brown, well circumscribed and well defined margins. does not grow in size (pig can inc). congenital or early onset.
freckle
flat tan hyperpig area 1-6mm that appears before age 3
dyplastic nevus
precursos to melanoma skin tumors. family Hx risk. highest risk for red hair and blue eyes. variegated brown to flesh color. irregular shape and raised areas in lesion. risk of melanoma doubles w/ dx of just one dyplastic nevus.
malignant melanoma
very fast metastases. 1-2% all CA deaths. onset 30-50yo. f>m. highest risk light skins. most common site upper back, also back and legs. excessive UV and sun exposure. irregular color, shape, size. tx: total excisional biopsy. 3x death rate of other skin cancers. 33-93% survival rate. pencil test.
solar keratosis
overexposure to UV light. same risk factors as actinic keratosis. nose and ears susceptible
polychondritis
inflammatory condition of the body’s cartilage. mostly ears, nose, and trachea. causes softening and collapse of those structures.
rhinophyma
sebaceous gland hyperplasia secondary to long standing rosacea. m>. tx: surgically
sarcoidosis
chronic granulomatous dz (basically a lung disorder). females 20-40 yo. sx: fever, wt loss, dry cough. may have purplish giant-cell granulomas-called lupus pernio nose. chance of acute polyarthritis, sjogren’s and uveitis. get purple, distorted looking nose.
scleroderma
rheumatologic ANA disorder causing progressive multi-organ fibrosis, esp skin, GI, and lungs. beaked nose, pulled small mouth with radial folds and teleangiectasias. CREST syndrome. rare. f>m. hands and fingers 1st affected. assoc w/ severe HTN and dry eye
allergic rhinitis
rhinitis. hay fever. drainage clear with itching
vasomotor rhinitis
clear drainage
rhinitis medicamentosa
clear drainage. inc in sx with overuse of decongestants
bacterial sinusitis
rhinitis. yellow to green drainage
epitaxis
drainage of blood due to trauma, inflamm, or drying
number one cause of sore throats and cough
post nasal drip (PND)
number one cause of PND
allergies
peutz-jeghers syndrome
telangiectasias and pigmented macules of lips and mouth. assoc w/ malignant GI polyps
aphthous ulcer
canker sore. painful
syphilis chancre
non painful
sicca syndrome
cobblestone appearance of the tongue. will have severe dry eye (inflamm based). will have polyarthritis. tend to be younger pts
leukoplakia
adherent thick plaque of white/gray yellow film. does not scrape off. is precancerous. assoc w/ tobacco chewing, smoking, irritation due to chewing on own cheeks.
thrush
oral yeast infection. creamy white patches of exudate. often on lips, sides of mouth, and tongue. scrapes off, bleeds when scraped. normal finding in children. abnormal secondary in adults (IDDM, NIDDM, long term ab use, nasal or inhaler corticosteroid use, immuno-suppressive dz).
halitosis
aka bad breath. recent food ingestion vs periodontal dz
parotid duct stones
can plug and stop normal salivation. sx: pain with salivation and eating. will be swelling of the duct. if red, will need ab. otc tx; have pt suck on lemon drops, if insuccessful refer to ENT for irrigation.
post nasal drainage (PND)
most common cause of sore throat. red/cobblestone look. pain worse in morning and late evening. may be related to allergies r drainage from infected sinuses. note color and type of drainage.
peritonsillar abscess
deviation in uvula. infection spreads to adjacent soft tissue. causes the uvula to deviate to the infected side. usually need to be drained but may drain on own.
neurological defects of 10th CN 9vagus)
causes the uvula to deviate away from the lesion or side affected. most common cause is stroke.
TMJ dysfunction/syndrome
dx is based on clinical findings: clicking of joint, tenderness of muscles, pain usually upon awakening, preauricuar aching, referred pain to ear
anterior blepharitis
scales around base of lashes. redness. thickened hypertrophic lid margins (tylosis)
blepharitis
generally staph (have exotoxins). add findings: SPK, conj injection, swollen lids, shallow ulcerations at lid margins, telangiectatic vessels, mild discharge. sx: itchy burning lid margin, FBS, tearing, crusting, madarosis, poliosis, trichiasis. freq seborrheic component. leading cause of marginal infiltrative keratitis. tx: lid scrubs, WCP, AT, ab ung, po ab
chronic marginal bleph, staphylococcal bleph, ulcerative bleph, seborrheic bleph, anterior bleph
synonyms of blepharitits
posterior blephritis/meibomianitis
factor in inspissated, clogged, congested, capped meib glands. assoc w/ seborrhea. inflamm appearance to post lid margin and palp conj. papillary response. tear film disturbances (frothy tears, rapid TBUT)
meibomianitis tx
WCP, lid massage, PO ab, ab-steriod combo
acne rosacea
assoc w/ meibomianitis/bleph. common skin dz of unknown etiology. hypertrophic sebaceous glands leading to inc sebum production. w>m. 30-50 yo. telangiectasias, papules, pustules, oily. rhinophyma. chronic hyperemia of malar surface. can have keratitis, recurrent hordeolum/chalazion. tx: topical ab steroid combo for quick fix, po doxy/tetracycline long term with taper
hordeolum
acute bact infection of zeiss, moll (both external), or meibomian (internal) glands. usually staph. tender, red, hot painful eyelid. lid swelling, lump, blocked meib orifice. may or may not see head. assoc: bleph, meibomianitis, acne rosacea. tx: WCP, topical abs. po ab for preseptal cellulitis. can progress to lid abscess
preseptal cellulitis
in front of orbital septum. usually from hordeolum. no APD, will have pain and low grade fever. swollen red eye
orbital cellulitis
behind orbital septum. ethmoid sinusitus. pain on eye movements (affects optic nerve), APD, higher fever. red swollen eye.
chalazion
granulomatous tissue formation generally at the site of a prev unresolved hordeolum. can be external or internal. sx: painless, hard, firm, round of elongated nodule. assoc w/ chronic bleph. tx; incision and curettage, injection of steroid.
demodex
mite that lives in hair follicles and sebaceous glands. subclinical unless abudant. hypersensitivity to toxins. itches and burns. signs: cylindrical collarettes around base of lash. hair follicle assumes raised, pyramid shape. tx: lid scrubs, WCP, vaseline
punctal stenosis
anatomical narrowing of the punctum. sx: epiphora, which may cause lid irritation. Jone’s test. tx: punctal dilation, surgical intervention if unsuccessful.
ectropion
outward turning of the eyelid margin. sx: epiphora, irritation, redness, burning, can also be asymp. assoc findings: secondary SPK, conj injection, keratinazation of the cornea or conj. make sure to check obicularis oculi function.
entropion
inward turning of the eyelid. sx: FBS, tearing, red eye, irritation. assoc findings: SPK, FB tracking, conj injection. tx: best option is surgery.
trichiasis
inward growth of eye lashes. sx: FBS, tearing, irritation, redness. secondary signs: SPK, conj injection, tearing vertical or irreg FB tracks. lower lid most often involved. r/o distichiasis (extra row of lashes). tx: removal.
pediculosis
infestation of lice on the eyelid margin. transmitted by direct contact. most often pubic lice. sx: mild to mod itching, irritation. usually bilateral. signs: crusty lid margins w/ brown discoloration (blood), nits, lice adhered to lashes and lid. may have conjunctivitis, PA node. tx: removal, petroleum jelly, OTC products.
blepharospasm
episodic involuntary contraction of the obicularis oculi muscle. usually bilateral. sx: intermittant or constant uncontrolled blinking, twitching, or closing of the eyelids. r/o dry eyes. tx: find underlying disorder, botox, surgery last resort.
essential blepharospasm
spastic complete forced closure. less common.
hemifacial spasm
unilateral contraction of the entire side of the face. present during sleep. brainstem damage
ocular myokymia
eyelid twitch brought on by stress, fatigue, caffeine
tic douloureux
wincing or tic secondary to trigeminal neuralgia.
tardive dyskinesia
assoc w/ long term antipsychotic meds. have oral-facial dyskinesia with restless and dystonic trunk and limb movements.
floppy lid syndrome
usually middle aged and heavy. upper lid easily everts, meaty lids, dark circles around eyes, vertical wrinkles, SPK, fine, velvey papillary rxn, delay in tear clearance, sx worse in the am (mild crusting and mucous discharge). chronic inflamm dz of the eyelids (long term hypoxia w/ intermittent periods of rapid perfusion of oxygen). spont evertion of lids during sleep. tx: shields, sleep on back, non-preserved lubricants or steriod, AT.
coloboma
incomplete closure of fetal fissure, congenital notch. usually unilateral. most common in sup,med lid. complicated by corneal exposure, dry eye. tx: lubrication for corneal exposure, surgical for exposure and cosmesis
epicanthus
prominent epicanthal folds, common in asian and cauc infants. assoc w/ wide, flat bridge. common cause of pseudostrabismus (pseudoesotropa).
dermatochalasis
bilateral draping of sup lid tissue over lid margin. familial tendency, usually elderly pts. specialized VF testing to justify surgery. r/o true ptosis. tx: blepharoplasty
lagophthalmos
incomplete closure of the eyelid. sx: FBS, irritation, red, burn, dry, chronic morning corneal irritation. signs: 2-5mm lid separation. can force complete closure on demand. sec corneal involvement: SPK, epith erosion, corneal anesthesia. tx: lubricants, tape lids at night, lateral tarsorrhaphy in severe cases, bandage lens.
madrosis
loss of eyelashes. uni or bilateral, usually in patches. eyebrow not usually involved. staph hypersensitivity most common. r/o trichotillomania
trichotillomania
neurotic twisting, twirling, or pulling out of hair
poliosis
whitening of eyelashes, loss of pigment of lashes. patchy or complete. most freq cause is staph. r/o vitiligo.
vitiligo
well defined hypopigmented or depigmented patches of skin. usually bilateral. onset usually before 20 yo. can affect any body surface. strong family tendency. slowly progressive. asymp. secondary poliosis. assoc w/ ocular syndrome VKH (vogt-koyanagi-harada). assoc systemic causes: thyroid, anemias, pituitary.
keratocanthoma
rare, elevated, firm, pink nodule with a keratin-filled central ulceration. begins as a erythematous papule. grows to a relatively large size then spontan resolves.
sebaceous cyst
well circumscribed, asympt fatty fibrous cyst caused by the blockage of the sebaceous gland duct. contains cheesy, yellowish material w/ a central punctum. becomes fibrous long term. common in inner and outer canthal regions. usually 2-5mm in size. can be superficial or subcutaneous. normal skin texture overlying. tx by drainage or excision.
sudoriferous cyst
fluid filled cyst of gland of moll. asympt, small, round, may be multiple. tx: puncture with hypodermic or cauterize
verrucae
viral wart. slow, insidious history.
xanthelasma
collection of lipid material in the dermis. yellow plaques in upper eyelid, most often medially, multiple, and often bilateral. cosmetic removal.
papilloma
most common benign tumor of the eyelid frequently seen on the mucocutaneous border. epithelial overgrown w/ rough surface. inc incidence w/ age. asymptom, various size and shape. may have broad base or pedunulated. black to amelanotic. tx: snip off if base is <2mm otherwise refer.
hemangioma
benign vascular tumor ranging in color from pink, purple, blue, red. usually noted at birth or early infancy
capillary hemangioma
most common. often superior nasal. lat, superficial, and rapidly growing. some resolve spontan, amblyopia threat. steroid injection therapy or laser.
canaliculitis
inflamm and infection of the canaliculus area. actinomyces is most common chronic cause. sx: tearing, discharge, red eye, mild tenderness over nasal aspect. signs: erythematous pouting punctum, surrounding red skin , mucopurulent discharge expressed, concretions expressed. tx: remove concretions, topical abs, let run course if viral.
dacryocystitis
infection of the lacrimal sac. often occurs when there is blockage of the nasolacrimal duct. signs: red, swollen tender area very medially lower lid and extending into the periorbital area. mucous or mucopurulent discharge may be expressed from the punctum. need an oral ab and WCP. watch for complications such as orbital or facial cellulitis. once acute infection is under control. refer for dacryocystorhinostomy.
acute dacryocystitis
afebrile: rx abs. febrile: hospitalize with iv abs
dacryoadenitis
infection/inflamm of the lacrimal gland. most often seen in children and young adults. can be acute or chronic. pretty rare. “S” curve eyelid. sx: pain, redness, swelling. signs: unilateral erythema, swelling, tender are over the outer 1/3 of upper lid. tearing, discharge, ipsilateral PA node, temporal chemosis of the conj, fever possibly inc WBC count. tx: bacterial-strong po ab or iv ab if mod to severe. viral-cool compress, tylenol
acute dacryoadenitis
bacterial: staph. aureus, N. gonorrhea, strept. viral: mono, influenza.
chronic dacryodadenitis
rule out lacrimal gland mass (tumor) or infiltrative dz (sarcoid, TB, syphilis, leukemia, etc.)
congenital NLD (nasolacrimal duct) obstruction
last portion of lacrimal system to canalize. sx: persistent tearing, chronic, mild discharge, matting. signs: “wet” eye, crusting in lids, may express discharge from punctum, skin may be irritated, affected area may be red, swollen. tx: digital massage, ab ung if sig discharge, WCP. most spont resolve, NLD probing on unresolved cases.
ptosis
drooping of the upper eyelid. classifications: neurological aponeurotic, myogenic, mechanical.
ptosis: neurological classification
CN III palsy: compressive or ischemic, hypotropia, exotroia “down and out”. w/ or w/o pupil sparing. horner’s syndrome:ptosis, myosis, anhydrosis. interruption of sympathetic chain. Marcus Gunn jaw-winking phenomenon: congenital unilateral ptosis w/ retraction of the lid when the pterygoid muscles are stimulated (ie. chewing). misdirection of CN III or aberrant regeneration: congenital or s/p CN III palsy. involunt, nonspecific movement of the upper lid during versions.
ptosis: aponeurotic
dehiscence, disinsertion, attenuation, stretching, degeneration of the levator aponeurosis. variable degrees of ptosis. gen good levator function. involutional: aging. thinned eyelid above the tarsus. bilateral. worsens as the day goes on. good levator function. postoperative: sec to bridle suture. blepharochalasis: rare, congenital. recurrent episodes of non-pitting edema lasting only days. over time lids become thin, atrophic, wrinkled. young adults.
ptosis: mechanical
lid edema, tumors, scarring
ptosis: myogenic
caused by a disorder of the levator muscle itself or at the neural-muscular junction. congenital or aquired
ptosis: congenital myogenic
congenital ptosis: dystrophy of levator. may also have superior rectus weakness. ptotic eyelid is slightly higher in downward gaze due to poor relaxation. astig and aniso common.
blepharophimosis
wide intercanthal distance, epicanthus inversus and congenital ectropion. about 50% of cases are amblyopic
ptosis: acquired myogenic
myasthenia gravis (MSG). ocular signs: ptosis, variable diplopia, Cogan’s lid twitch (look down, look straight-eyelids will overshoot.
