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Oculoplastics > Word association > Flashcards

Word association Flashcards

1
Q

Order of frequency of muscle involvement in TED

A

Inferior rectus > medial rectus > superior rectus > lateral rectus

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2
Q

Antibodies in Graves

A

Antithyroglbulin (anti-Tg)
Anti thyroid peroxidase (AntiTPO)
Anti TSH receptor (TBII)

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3
Q

Phacomatous choristoma

A

Inferonasal orbital choristoma of lens material; seen in young children. Benign.

= Zimmerman’s tumor

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4
Q

Poor prognostic feature of sebaceous carcinoma

A

Upper lid location more associated with death

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5
Q

Canaliculitis

A

Actinomyces

Sulfur granules

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6
Q

Lacrimal sac tumor

A

Transitional

Squamous

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7
Q

Orbital tumor in adult

A

Cavernous hemangioma

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8
Q

Malignant orbital tumor in adult

A

Lymphoma

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9
Q

Malignant orbital tumor in child

A

Rhabdomyosarcoma

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10
Q

Primary intraocular tumor in adult

A

Melanoma

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11
Q

Primary intraocular tumor in child

A

RB

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12
Q

Intraocular tumor

A

Metastasis

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13
Q

Antibiotics in pediatric preseptal or orbital cellulitis

A

Cephalexin if anterior

Amox/clav if sinus

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14
Q

Preseptal cellulitis in child under 5

A

Bacteremia, septicemia, meningitis 2/2 H flu (now less common, in the setting of vaccine)

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15
Q

Risks associated with MRSA cellulitis

A

Nec fasc, orbital cellulitis, endogenous endophthalmitis, panophthalmitis, cavernous sinus thrombosis

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16
Q

When is admission warranted for preseptal?

A

48h failed PO abx, orbital sg/sx

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17
Q

Location of abscess in orbital cellulitis

A

Subperiosteal

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18
Q

Infectious agent category - adult v child

A

Gram pos cocci

Mixed in adult
Single agent in child

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19
Q

When to drain an abscess in orbital cellulitis

A 
Older than 9 yo
Frontal sinusitis
Nonmedial location 
Large abscess
Suspicion of anaerobic agent
Recurrence after prior drainage
Chronic sinusitis (e.g. polyps)
Optic nerve or retinal compromise
Dental origin (suggests anaerobic)
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20
Q

Signs of posterior extension of orbital cellulitis

A

Proptosis
Ophthalmoplegia
Anesthesia is V1/V2

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21
Q

Nec fasc

A

Group A beta-hemolytic strep
Pain out of proportion
Numbness
Shock

Clinda

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22
Q

Branching, nonseptate hyphae stain w H&E

A

Zygomycoses : mucor or rhizopus

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23
Q

Branching hyphae is uniform width

Grocott-Gomori methenamine silver nitrate

A

Aspergillosis

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24
Q

Parasitic organisms of the orbit

A

Taenia soleum
Ecchinococcus
Trichinosis

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25
Q

Pathogenesis of TED

A

T cell CD154 binds fibroblast CD40

IL6, IL8, PGE2

Hyaluronan and GAG
Transformation to adiposite

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26
Q

IV steroid does for TED

A

500mg-1 g methylprednisolone 6-12wk

Or oral 1 mg/ kg

Bridge to radiotherapy/sx

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27
Q

IgG4 Disease

A 
Orbitotopathy
Dacryoadenitis
Xanthogranuloma
Orbital amyloidosis
Nonspecific inflammation
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28
Q

What type of hypersensitivity is vasculitis

A

Type 3 hypersensitivity (immune complex-mediated)

29
Q

Localization of NSOI

A 
EOMs (not sparing muscle insertion)
Lacrimal gland
Anterior segment
Apex
Diffuse
30
Q

Treatment of sclerosing NSOI

A

Aggressive systemic immunosuppression

Responds poorly to steroids or to radiation

31
Q

Hemangiomas in adults and in children

A

Capillary = Infantile

  • enlarge over 12 months; 75% involute by 3-7yo
  • high flow

Cavernous = adult
- encapsulated, low-flow

32
Q

Risk factors for infantile hemangioma

A

Female
Low birth weight
Prematurity
Maternal chorionic villus sampling

33
Q

Location of infantile hemangioma

A

Superonasal orbit

Medical upper lid

34
Q

Systemic associations for capillary hemangioma

A

Neck hemangioma (airway)
Visceral (thrombocytopenia)
= Kasabach-Merritt

35
Q

Most common benign orbital neoplasm in adults

A

Cavernous hemangioma

36
Q

Hemangiopericytoma

A

Clinically similar to cavernous hemangioma

Blue intra-op

Composed of pericytes

Uncertain metastatic potential from path

COMPLETE EXCISION, given metastatic risk

37
Q

Orbital lymphatic malformation

A

= lymphangioma = venous + lymphatic

Congenital

Apparent 1st or 2nd decade

Enlarge w URI

Tx w sclerosing agent

Associated with intacranial AVM

38
Q

Grape-like cystic lesion

A

Lymphatic malformation

Also w fluid layering of blood products

39
Q

Orbital varix

A

Low-flow

Enophthalmos at rest — proptosis with valsalva or dépendent head positioning

40
Q

TX AVM

A

Sélective occlusion of feeders

Risk or exsanguination

41
Q

AV Fistula

A

Direct C-C

  • ICA + cavernous sinus
  • Trauma
  • High flow = tortuous episcleral vessels, bruit, pulsative proptosis
  • sequelae: anterior uveitis, blood @ Schlemm, choroidals, IOP elevations

Dural C-C

  • meningeal branches off medicine
  • age/ OCD;
  • degenerative/HTN
  • lower flow — XR angiogram gold standard, but MRI accepted as safer
42
Q

Chiasmal involvement in optic nerve glioma

A

50%

43
Q

Intracranial associations of optic nerve glioma

A

ICH

Reduced hypothalamic and pituitary function

44
Q

Glioblastoma sg sx

A

Pain, vision loss, swelling/hemorrhage of nerve head

Poor prognosis

45
Q

Fibrous histocytoma

A

Less than 10% metastatic, but are locally aggressive

Fibroblast and histiocyte

46
Q

Solitary fibrous tumor

A

Spindle cells
CD34 positive

Metastatic potential w incomplete excision

47
Q

Fibrous dysphasia

A

Hyperostotic bone without dural enhancement

Albright syndrome w cutaneous pigmentation, endocrine disorders

Resection c debulking as needed

48
Q

Common presentations of orbital lymphoma

A

Non Hodgkin B cell (90% of malignant). 4 types:

MALT - 40-60%; may have chlamydia association in conj (H pylori in GI). May go into remission or transform, usually higher-grade

CLL
Folicular Center
High grade (large cell, lymphoblastic, Burkett)

49
Q

Medial fullness with respect to medial canthal tendon

A

Superior: encephalocele

Inferior: lacrimal sac distension

50
Q

Epiphora in infant—important pertinent positive/negative

A

Mucopuruent discharge (localize to upper or lower)

51
Q

Site of blockage in congenital NLDO

A

Valve of Hasner, nasal end of NLD ~20-22mm from nostril

52
Q

Percentage NLDO resolving by age 1

A

90%

53
Q

Percentage NLDO resolved with probing

A

90%

54
Q

Basal tear secretion test

A

Anesthestic in
Strip in 5 min
Normal = 10-15

55
Q

Schumer 1 v 2

A

Schirmer I: no anesthesia, paper in eyelid, measure tears

Schrumer 2; fatigue block sign, nasal stimulation x2 min incr reflex tear

56
Q

Tests in suspected NLDO

A

Dye disappearance (5min; asymmetry in drainage), nasal secretion, irrigation, Jones I and Jones II

57
Q

What are the Jones 1 and Jones 2 tests?

A

Jones 1 - primary dye test: fluroescein to fornix and check at inferior meatus at 2 and 5 min
(Not commonly done)

Jones 2 - after Jones 1, irrigation of lacrimal system and test for fluroescein in irrigant solution

58
Q

If lacrimal system irrigation results in distension of lacrimal sac, but reflux, where is obstruction

A

Valve of Rosenmuller

59
Q

Epilation effect duration

A

3 weeks

60
Q

Corneal ulcer with negative culture not responding to treatment

A

Anesthetic abuse

Presents as an abrasion and tends to progress to KP, infiltration, incl ring infiltrate

61
Q

Drug induced cicatricial pemphagoid

A

Subconj fibrosis in the setting of long term gtt use (e.g. miotics) causing scarring of fornix, symblepharon, pannus, punctual stenosis

Confirm w conj bx

62
Q

Primary lumbar stem cell deficiency

A 
PAX6 mutation (aniridia)
Ectodactyl-ectodermal dysplasia-clefting syndrome 
Sclerocornea 
Keratitis-ichthyosis-deafness syndrome
Congenital eryrhromeratodermia
63
Q

Secondary causes of lumbar stem cell deficiency

A 
Radiation 
Chemical burn 
Thermal burn
Toxic medication —long term (pilo, antimetabolite, keratitis-inducing meds)
PTG
Inflammatory disease (pemphagoid, SJS)
Infectious conjunctivitis (trachoma)
Dysplasia/neoplasia
64
Q

LADD

A

Lacrimal-auriculo-dental-digital syndrome
= Levy-Hollister

Assd w limbal stem cell deficiency

65
Q

Surgical management of limbal stem cell deficiency

A

SCL

Autograft if 1 eye
Allograft or Kpro if bilateral

66
Q

Blepharophimosis syndrome

A

AD in FOXL (ch3)
AKA: blepharophimosis-ptosis-epicanthus inversus (BPES)

Blepharophimosis (narrow palpebral fissure)

Proptois — dysplasia of levator aponeurosis

  • Can cause ambly
  • Usually treat this last

Telecanthus — I.e. normal interpupillary distance, but wide intercanthal distance

Epicanthus inversus — skin fold covers medial canthus

Premature ovarian failure (type 1 only)

67
Q

Breslow Depth

A

Melanoma in situ - epithelial

Stage I - 0.8mm “early melanoma” (excision)

Stage II - 0.8-4.0mm and/or ulceration (excision + LN)

Stage II “thick” - > 4mm — higher risk of metastatic spread, 50% survival at 5 years, rec LN biopsy

Stage III - metastasis; ulceration plays prognostic role, Breslow depth does not

68
Q

High-flow CC fistula

A

Internal carotid rupture or leak within the cavernous sinus

Severe proptosis, diffuse ophthalmoplegia, CRVO, arterialization of conjunctival vessels

Oculoplastics (1 decks)

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