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237 Cards in this Set
- Front
- Back
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Ginkgo biloba
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- blood thinner
- retinal hemorrhage, hyphema, retrobulbar hemorrhage |
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Niacin (aka?)
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Vitamin B3
- found in poultry, fish, legumes, yeast - lowers cholesterol - CME - dose dependent (resolves w/DC) - dry eyes and blurred vision |
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Echinacea purpurea
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Tx colds and influenza symptoms, URI, UTIs
ocular effects when used on eyes - Conjunctivitis - Eye irritation - resolves w/DC |
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Canthaxanthine
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Carotenoid - found in crustaceans, chanterelle mushrooms, pink colored fish
- Visual changes = retinal sensitivity - Crystalline retinopathy |
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Chamomile
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Tea - active ingredient = Quercetin
Anti-inflammatory agent - often used for eye irritation and inflammation; stye - Conjunctivitis = when applied topically (same as echinacea) |
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In which pts must you avoid using chamomille topically?
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Pts with allergic rhinitis
conjunctivitis is most likely an allergic rxn to the pollen |
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Red Yeast Rice (Monascus purpureus)
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Naturally occuring lovastatin - lowers cholesterol
- Conjunctivitis, rhinitis, sneezing in allergic pts |
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Angel's trumpet (Datura stramonium)
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Once used for analgesia; used orally as hallucinogenic
* Anticholinergic properties (similar to atropine, scopolamine, hyoscyamine) - blurred vision and mydriasis - dry mouth, urinary retention, confusion/combative behavior, halucinations, life-threating anticholinergic syndrome |
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What is known as "Jimson weed"?
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Datura (Datura wrightil)
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Jimson weed (Datura)
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tx eye inflammation, asthma, bronchitis and as hallucinogenic
smells of sweat causes blurred vision and mydriasis (same as Angel's trumpet) |
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In which pts must you avoid using Jimson weed (datura)?
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Pts with narrow angle glaucoma or ocular adhesions
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St. John's Wort (Hypericum perforatum)
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used for teas and tablets; has NO indication for the eye
used for depression, anxiety, sleep disorders * Hypericin is photoactive in high doses --> leads to photosensitivity and/or cataracts |
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Licorice (Glycyrrhiza glabra)
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Used for inflammatory eye disorders and GI upset
- COX inhibitor - medicinal effects from glabridine * HIGH doses lead to vision loss = vasospasms of brain, retinal, or optic n. blood vessels |
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Which pts must you avoid giving licorice?
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Pts with migraines
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Bitter orange extracts
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Uses = Heartburn, loss of appetite, nasal congestion and weight loss
- contains synephrine - topically used for inflammation of eyelid, conjunctiva, and retina (possibly used for retinal hemorrhaging) |
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Ocular side effects of bitter orange extracts
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Large amts of OXYPEUCEDANIN --> causes photopigmentation
* photosensitivity - esp. in light skin |
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What are the 2 most expensive causes of visual impairment?
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Cataracts and ARMD
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What is the leading cause of blindness in people over 50?
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ARMD
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Risk factors for ARMD?
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1) low intake of dietary antioxidants and zinc
2) dietary intake in excess of saturated fats 3) elderly white female 4) low macular pigment density 5) HTN |
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Commonly used Natural meds for ARMD
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Carotenoids = Beta-carotene, lutein
Misc. = Zinc Antioxidants = Astaxanthin, Ginkgo, grape seed, Vit. A, Vit C, Vit E Omega 3 = DHA, EPA |
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Which meds for ARMD are likely safe but have insufficient evidence for effectivity?
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Vit. A
Ginkgo |
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Which med for ARMD has insufficient evidence for safety AND effectivity?
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Astaxanthin
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What were the primary findings of the AREDS?
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significant reduction in risk of ARMD due to antioxidants and zinc, although no significant effect on progression of cataract
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What meds were included in AREDS?
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Beta-carotene, Vit. C, Vit. E, elemental Zinc
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What did AREDS2 evaluate?
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effect of dietary xanthophylls (lutein and zeaxanthin) w/ and w/o omega3 long chain polyunsaturated fatty acids
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Why was the dosage of zinc changed in AREDS2?
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Due to smokers developing cancer
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What was a major disadvantage of AREDS2?
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There was secondary development of age-related cataracts
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What is the MAIN herbal supplement used for the eye?
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Lutein
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What ocular improvements does Lutein have?
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improve symptoms of AMD such as macular pigment optical density and glare recovery, near vision acuity, and contrast sensitivity
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What is a major effect of Lutein in the retina?
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* Prevents free radical damage
more effective than beta-carotene * filters damaging blue light * selectively binds tubulin to improve structural integrity of retina |
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Astaxanthin
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Carotenoid pigment
Powerful antioxidant * crosses BBB --> accumulates in retina * decreases photo-bleaching of retina from exposure to high intensity light |
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Vitamin A
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Fat soluble vit. stored in liver - available in retina, kidney, lungs, adrenals
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What is the ingested form of Vit. A?
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Retinol
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What happens during retinol deficiency?
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RBP binds and accumulates in the liver
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What does extreme Vit. A deficiency lead to?
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* permanent blindness
* Xerophthalmia * Night blindness * Alopecia of eye lashes |
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Beta-carotene
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Carotenoid, fat soluble compound
Converted to active vit. A Found in: grains, oils, red orange and yellow fruits and veggies |
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What is DHA and what is it imp. for?
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Docosahexanoic Acid
Important for rod cone development and structure |
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What are pts with low intake of DHA and EPA more likely to develop?
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Retinitis Pigmentosa and have 33% increased risk of incident AMD
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What are some ocular indications for use of DHA+EPA?
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AMD prevention
Vision enhancement Dry eye prevention omega 3 fatty acids also known to reduce blood pressure slightly |
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What are 2 suspected actions of Ginkgo biloba?
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1) prevent macular degneration
2) improve long distance vision |
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What other drugs must Ginkgo not be used with?
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Warfarin or aspirin
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What are grape seeds used for?
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Antioxidant - Oligomeric Proanthocyanidins (OPC)
- may prevent or relieve vision problems - long term safety unknown |
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What is the LEADING cause of impaired vision for ALL people in North America?
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Cataracts
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What are some commonly indicated meds for prevention of cataracts?
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* Aldose Reductase Inhibitors = methoxylated flavones, Quercetin (Chamomile)
* Protein Glycosylation Inhibitors = Acetyl-L-carnitine, Alpha-ketoglutarate, Carnosine, Pyruvate * Misc. = Niacin, Riboflavin * Antioxidants = alpha-lipoic acid, beta-carotene, bilberry, glutathione, lutein, lycopene, selenium, Vit. C, Vit. E |
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What are the safest and possibly effective meds for prevention of cataracts?
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Lutein
Niacin Riboflavin |
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What is the main indication for ALA (Alpha-lipoic acid)? What are its other ocular indications?
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Diabetes
Retinopathies and glaucoma |
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What is ALA? What % is absorbed from diet?
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Co-enzym w/antioxidant properties that decrease free radical damage
- helps in recycling Vit C, Vit E and glutathione back to their oxidative states ~ 30% from diet |
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What is the correct dosage for Lutein as a supplement?
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15 mg 3x/week
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What is the indication for usage of 6mg lutein daily?
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decreased risk of development of cataracts
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What type of molecule is Niacin?
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NOT an antioxidant
* associated with coenzymes NAD and NADP which are used for powerful antioxidative mechanisms |
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What are some systemic effects of Niacin?
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Skin flushing
rash Intestinal/stomach upset |
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What is another name for Riboflavin?
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Vitamin B2
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Taking a combo of riboflavin and niacin supplementation for 6 yrs was assoc. with what reduction in incidence of cataracts?
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up to 44%
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How does Bilberry work?
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Contains anthocyans
Powerful antioxidant * May improve microcirculation --> exerts direct effects on retina --> alteration of local enzymatic rxns * Accelerates rhodopsin regeneration |
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What are the ocular uses for Bilberry?
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* Nocturnal vision when used for long periods of time
* Diabetic Neuropathy * Glaucoma -- reported to lower intraocular pressure and improve ocular blood flow |
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What are 6 natural meds used for glaucoma?
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1. cod liver oil and other fish oils
2. Ginkgo biloba 3. glucosamine sulfate 4. forskolin 5. marijuana (cannabis sativa) 6. Vit. C |
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What med has the highest effectivity and safety for txment of glaucoma?
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Ginkgo --> taken orally appears to improve pre-existing damage to visual field in pts with normal tension glaucoma
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What are the ocular SIDE effects of Grape seed?
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Can cause progressive damage to the retina due to sustained high sugar concentration in blood vessels
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What is the Std of care for pts with AMD and high risk characteristics?
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Supplementation with AREDS nutrients
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What is the importance of what AREDS2 explored?
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How diet and lifestyle attenuate risk of AMD
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What foods contain high amts of ALA?
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Salmon, herring, sardines, tuna
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What number of Americans suffer from severe visual impoairment?
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~1.8 million
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How many Americans are considered legally blind?
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~1.3 million
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Genetics account for what % of early onset vision loss?
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50%
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Slit lamp findings assoc. with Alagille Syndrome?
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AD liver dz
* Extra circular line on cornea |
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SL findings - Primary congenital glaucoma
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sporadic / AR eye dz
* enlarged cornea * corneal clouding * Haab's striae |
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SL findings - Myotonic muscular dystrophy
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AD neuromuscular dz
* cortical cataracts w/ mild/adult onset form |
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SL findings - Lysosomal storage dzes (40+ dzes)
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AR, X-linked storage dzes affecting variety of systems
* corneal clouding, corneal opacities, cataracts |
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SL findings - Marfan dz
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AD conn. tissue dz
* dislocated lens, glaucoma, cataracts |
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SL findings - Neurofibromatosis 1
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AD neurocutaneous disorder
* lisch nodules |
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SL findings - Wilson's dz
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AR copper accumulation --> liver dz
* Kayser Fleischer rings around cornea |
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Chromosomal Abnormalities
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Down syndrome (Trisomy 21)
Cat Eye Syndrome |
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What is the etiology of Down Syndrome?
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95% sporadic non-disjxn
4% translocation 1% mosaic |
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Ocular findings in Down Syndrome (Trisomy 21)
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* Brushfield Spots = fmall white spots on periphery of iris --> 90% of DS
* Cataract * Epicanthal folds and upslanting palpebral fissures |
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What is Cat Eye Syndrome?
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Duplication 22pter-q11
- mild mental retardation * Iris, choroid or retinal coloboma - cardiac defects - anal atresia |
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Characteristics of Coloboma assoc. w/ Cat Eye Syndrome
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- defect of retina and underlying choroid w/ or w/o defect in inf. iris
- may or may not affect optic n. - failure of optic vesicle to fuse - normalization of appearance obtained w/contact lens - most located at 6:00 |
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What are the 5 Inheritance Patterns?
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1. AD
2. AR 3. X-linked 4. Mitochondrial 5. Complex |
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Autosomal Dominant conditions
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Neurofibromatosis (1 and 2)
Alagille Syndrome Marfan Syndrome Myotonic Dystrophy Waardenburg Syndrome CHARGE Syndrome Stickler Syndrome |
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Autosomal Recessive conditions
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Wilson's Dz
PXE Homocystinuria Bardet-Biedl Syndrome |
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X-linked conditions
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Incontinentia Pigmenti
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Complex Inheritance
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Aniridia
RP Congenital Glaucoma |
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Mitochondrial Disorder
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Leber's Hereditary Optic Neuropathy
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Lysosomal Storage Disorders
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Fabry Dz
Mucopolysaccharidosis I etc. |
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Which Neurofibromatosis exhibits incomplete penetrance?
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Schwannomatosis
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Main differences b/ween NF1 and NF2
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NF1: 1:4,000 ; chromosome 17 neurofibromin ; GTPase activating protein
NF2: 1:40,000 ; chromosome 22 Merlin/schwannomin ; cytoskeletal protein |
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What are Lisch nodules and which NF are they assoc. with?
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HIGHLY specific to NF1
* raised melanocytic hamartomas on the iris - usually appear after 6 - do not affect vision |
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What are the 7 Diagnostic Criteria of NF1?
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1. >/= 6 cafe-au-lait spots (5 mm pre-pub, 15 mm post-pub)
2. Skin-fold freckles 3. 2 or more neurofibromas/one plexiform neurofibroma 4. Lisch nodules 5. Optic glioma - check for clinical signs 6. Char. skeletal dysplasia - tibia and orbit 7. Affected 1st deg. relative |
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What is the name of the Dz assoc. with NF1? What is the prevalence?
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Von Recklinghausen Dz
1:10,000 |
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What are the indications for genetic testing in NF1?
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individuals at 50% risk
children w/single sign individuals w/variant disorders --> Legius Syndrome Prenatal testing |
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What are the ocular findings assoc. with NF2?
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Post. subcapsular lens opacities often progressing to cataracts
Children - amblyopia |
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What findings are assoc. with NF2?
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Central form
Bilateral acoustic neuromas Meningiomas/Schwannomas |
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Diagnostic criteria for NF2
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* CT/ MRI showing bilateral vestibular schwannomas (acoustic neuromas)
* parent w/NF2 and one of the following: CT/MRI showing unilateral acoustic neuroma or two meningiomas/schwannomas or cataract * Unilateral vestibular schwannomas and 2 meningiomas/schwannoma or cataract |
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Ocular findings assoc. with Alagille Syndrome
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* Post. embryotoxin common --> 75% of pts
* Axenfeld anomaly = iris attachment to Descemet's * RP, pupillary abnormalities, and anomalies of optic disc |
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Char. facial features of Alagille Syndrome
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prominent forehead, deep-set eyes w/moderate hypertelorism, pointed chin, and saddle or straight nose w/bulbous tip
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What gene is assoc. with Alagille Syndrome?
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JAG1 gene
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What gene is affected in Marfan's Syndrome?
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Fibrillin gene (FBN1)
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What are the ocular findings in Marfan's Syndrome?
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* Ectopia lentis - 50% of pts --> usually sup and temp
- flat cornea - increased axial length - cataract in pts under 50 - hypoplastic iris or ciliary muscle causing decreased miosis - myopia regardless of lens placement - glaucoma - retinal detachment |
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What are the classical features of Myotonic Dystrophy?
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Cataract
Myotonia Cardiac conduction abnormalities Muscle weakness and wasting Myotonic facies Life span may be normal |
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What are the char. of Waardenburg Syndrome?
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Heterochromia
White forelock Hearing loss Hypertelorism Dysoptia Canthorum (lateral displacement of inner canthii) Broad nasal bridge |
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CHARGE Syndrome
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Coloboma
Heart defect Atresia choanal Retardation of growth Genitourinary anomalies Ear abnormality |
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Characteristics of Stickler Syndrome
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* Cleft palate/Piere Robin SEquence
* hearing loss * flat face/depressed nasal bridge * myopia * retinal detachment * hyperextensible jnts |
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What is Wilson's Dz a problem with and how is it txed?
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disorder of copper metabolism --> copper overload
Txed with chelating agents to remove copper, zinc and antioxidants |
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Char. of Wilson's Dz
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Elevated liver copper levels
Kayser-Fleischer ring LIver failure Psychiatric or personality disorder Neurologic signs: dysarthria (slurred speech), dystonia (movement disorder), rigidity, tremor |
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What are the clinic. char. of PXE?
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skin changes
retinal changes (angioid streaks), loss of central vision calcification of arteries and decreased blood flow in extremities GI changes |
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Char. of Angioid streaks found in PXE
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* typically bilateral
* usually appear before 10 y/o * Present in ~50% of ppl w/PXE |
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Mechanism of action in Homocystinuria
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disorder of methionine metabolism --> urea cycle disorder
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What are the clinical features of Homocystinuria?
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* myopia
* lens dislocation * glaucoma * increased risk for blood clots * failure to thrive * mental retardation, psychiatric disturbance, seizure |
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What is the txment for Homocystinuria?
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limit methionine, cystine supplementation, vitamin B6, betaine
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Characteristics of Bardet-Biedl Syndrome
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- obesity
- polydactyly - pigmentary retinopathy (rod-cone dystrophy) - cognitive impairment - genital anomalies - Renal and cardiac abnormalities |
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Characteristics of Incontinentia Pigmenti
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discolored skin, brain involvement, eye abnormalities, nails and hair
Neurological problems include cerebral atrophy and the loss of neurons in the cerebellar cortex, seizures |
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What is the classical eye finding in IP? What % of IP patients have normal vision?
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Abnormality in the growth of the blood vessels of the retina
>90% of IP patients have normal vision |
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What type of inheritance does Aniridia have?
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* Complex
- sporadic - isolated --> Autosomal Dominant - Associated w/Wilm's Tumor (WAGR) |
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What is the condition formerly known as rod-cone dystrophy?
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Retinitis Pigmentosa
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Characteristics of RP?
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Night blindness
Peripheral vision loss Tunnel vision loss of mostly rods eventual atrophy of retinal tissue |
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What are the inheritance patterns for RP?
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* Complex
- Unknown = 40-50% - AD = 15-25% - AR = 5-20% - X-linked = 5-15% |
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What is the difference b/ween Infantile and Juvenile Congenital Glaucoma?
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Infantile = w/i first 3 yrs of life
Juvenile = after 3 yrs |
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Is congenital glaucoma more prevalent in males or females? Is it unilateral or bilateral?
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65% males over females
70% bilateral |
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What type of inheritance does JUVENILE open angle glaucoma have?
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AD
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What are the characteristics of Leber's Hereditary Optic Neuropathy?
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* bilateral, painless, subacute visual failure that develops during young adult life
* Males 4-5x more affected than females * Usually asymptomatic until visual blurring occurs affecting the central VF in one eye * 25% = bilateral onset * optic disk atrophic 6 wks after onset |
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How is Leber's Hereditary optic neuropathy transmitted?
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Affected males do not transmit
Affected females transmit to ALL of their offspring |
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What are Lysosomal Storage Disorders?
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* Enzyme deficiency causes lysosomes to become swollen
* Family of over 40 dzes * Each dz is a consequence of type of substrate and where it accumulates |
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Gaucher, Niemann-Pick type A and Tay Sachs are what types of diseases and what ethnic group are they most commonly seen in?
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Lysosomal storage disorders
Ashkenazi Jews |
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Infantile onset Pompe dz is most commonly seen in what ethnic group?
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African Americans
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SL findings of Fabry Dz
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corneal whorling
corneal opacities lens opacity |
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SL findings of Galactosialodosis
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macular cherry red spot
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SL findings of GM 1 Gangliosidosis
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diffuse corneal clouding
macular cherry red spot |
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SL findings of Mannosidosis
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lens opacities
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SL findings of Mucolipidoses (types II, III, IV)
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corneal clouding
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SL findings of Mucopolysaccharidoses (types I, IV, VI, VII)
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corneal clouding
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SL findings of Niemann Pick Dz
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corneal opacification
macular cherry red spot |
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SL findings of Sandhoff Dz
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progressive visual inattention
macular cherry red spot |
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SL findings of sialidosis (type I and II)
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corneal and lens opacities
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SL findings of Tay Sach's Dz
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progressive visual inattention
macular cherry red spot |
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Which form Mucopolysaccharidosis has a CLEAR cornea? What is another name for this specific disorder?
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MPS II
Hunter's Syndrome |
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Which form of MPS exhibits corneal opacities and corneal clouding?
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MPS VI
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Which 5 LSD's exhibit a macular cherry red spot?
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Tay Sachs
Niemann Pick Sandhoff Galactosialodosis GM1 Gangliosidosis |
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What 3 Lysosomal Storage Disorders are X - linked? What is the inheritance pattern for the majority of LSDs?
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Fabry, MPS II, Danon
Majority are AR |
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What is the most common ocular finding in Fabry Dz?
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Corneal whorling
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What happens to the lens in Fabry dz?
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* Granular ant. capsular or subcapsular deposit --> wedge shaped w/base at lens equator and apex at center --> spoke like deposits
* post. lens opacity = Fabry cataract --> suggestive of Fabry dz |
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What are the signs of Fabry dz on conjunctiva and retina?
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Sausage-like and markedly dilated and tortuos vessels
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What is the avf life expectancy in Fabry Dz? What do pts normally die from?
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* 50 years
* Renal, cardiac or cerebrovascular complicationsW |
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What is used to confirm the diagnosis of Fabry Dz?
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Enzyme assay --> males w/ classical Fabry usually have less than 1% of normal enzyme levels
Genetic testing to identify females |
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What are the txment options for pts with Fabry Dz? What is the primary one?
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Supportive care = pain management, valve replacement, dialysis or renal transplantation
Enzyme Replacement Therapy - Fabrazyme |
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What drugs can cause corneal whorling similar to Fabry Dz?
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Amiodarone (Cardarone) - antiarrhythmic
Chloroquine (Aralen) - malaria Chlorpromazine (Thorazine) - psychotic disorders Indomethacin (Indocin) - NSAID Meperidine (Demerol) - pain Tamoxifen (Nolvadex) - breast cancer |
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What systemic findings should you look for if you see Vortex Keratopathy?
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difficulty sweating
pain in hands or feet angiokeratoma (skin rash) protein in urine cardiac dz cerebrovascular dz family hx |
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What is the physical appearance of someone with Mucopolysaccharidosis I (MPS I)
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Facial dysmorphism
short nose flat face prominent forehead large head (scaphocephaly) |
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What is the spectrum of MPS I?
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MPS I S = "Scheie" = Attenuated
MPS I HS = Hurler Scheie - mid MPS I H = Hurler = Severe |
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What are the ocular manifestations of MPS I?
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* Corneal clouding - can begin in 1st yr of life; ground glass appearance; may lead to blindness
* retinal degeneration - peripheral loss; night blindness * glaucoma * photophobia * optic n. dz - may lead to blindness |
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What are the systemic manifestations of MPS I?
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skeletal deformities
carpal tunnel syndrome short stature umbilical/inguinal hernia hepatosplenomegaly |
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How are the ocular manifestations of MPS I txed?
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corneal transplant
sunglasses/hat ophthalmic drops (beta blockers/steroids) |
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What is the inheritance of MPS I?
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Autosomal Recessive
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What are the txment options for MPS I?
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Supportive care
Hematopoietic stem cell transplantation Enzyme replacement therapy - Aldurazyme |
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What is the Optimal Path to Dx?
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1. Clinical suspision = finding of a unique sign or symptom; presentation of a cluster of common signs or symptoms
2. Urgent referral to geneticist or metabolic specialist 3. Definitive dx = enzyme assay (gold std); DNA testing |
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What skin condition is known as pre-cancer to squamous cell carcinoma?
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Actinic Keratosis - sun exposure
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What is actinic keratosis of the lips?
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Actinic Chelitis
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How does Actinic Keratosis clinically present?
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- rough and dry skin lesion
- patch or growth on skin: * sun-exposed areas * gray, pink, red or same color as skin * begin flat and scaly * develop hard and wart-like or gritty, rough and sandpapery surface --> may develop horn-like texture * sometimes easier to feel than see |
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What can be done to reveal any cancerous changes to an actinic keratosis lesion?
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skin biopsy
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How is AK txed?
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* burning (electrical cautery)
* curettage and electrodesiccation (scrapes away lesion and uses electricity to kill any remaining cells) * excision * cryotherapy * 5-fluorouracil and Imiquimod - creams usually cause irritation and redness to destroy the precancerous growth and leave behind normal skin |
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What are the 3 major types of skin cancer?
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Basal cell carcinoma
Squamos cell carcinoma Malignant melanoma |
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What type of cancer makes up the majority of new skin cancer cases? What is the %?
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Basal cell carcinoma --> 80%
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Where are the majority of basal cell carcinomas found?
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90% found on head or neck and other sun exposed areas
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What is the name of the sx that has a high cure rate for basal cell carcinoma?
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Moh's sx
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What is the cure rate for Squamous cell carcinoma?
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90% cure rate
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What do squamous cell carcinomas develop from?
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actinic keratosis
chronic irritations or scars |
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What is the only type of skin cancer that does not metastasize?
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Basal cell
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What is the txment for BCC and SCC?
|
* Prevention and early dx
* surgical excision * Mohs surgery * Topical chemotherapy cream - 5-fluorouracil/Imiquimod * Radiation therapy |
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What is the most fatal form of skin cancer?
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Malignant melanoma - one person dies every hour in this country
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Malignant melanomas make up what % of skin cancers? What % of skin cancer deaths are they responsible for?
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Make up 4% of skin cancers
Responsible for 80% of skin cancer deaths |
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Which type of skin cancer is incurable?
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All curable if detected early enough
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What are the 5 different types of melanomas?
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1. Lentigo
2. Superficial spreading 3. Nodular 4. Acral Lentiginious 5. Amelanotic |
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ABCDE's of Melanoma
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A = assymmetry
B = borders C = color changes D = diameter (>6mm) E = elevation |
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What are the char. of Superficial spreading melanoma?
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* grows as a small plaque for 6-24 mos then develops nodule
* highly invasive * 90% cure rate w/complete excision in plaque stage * poor prognosis after nodule develops |
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Description of superficial spreading melanoma
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* macula/patch
* light brown/dark brown/pale red * blurred, irregular borders |
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What are the differential diagnoses for SSM?
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Solar lentigines
Moles Seborrheic keratoses Dermatofibromas Pyogenic granulomas Pigmented basal cell |
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Amelanotic Melanoma is considered a variant of what other type of melanoma?
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Nodular melanoma
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What are the key things to look for in a melanoma?
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* Enlarging
* Asymmetric * Irregularly bordered * Variably colored * Large (over 6mm) * Black color suspicious * First flat then becomes nodular * may bleed and ulcerate |
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How is a melanoma diagnosed?
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Dermoscopy
Excisional biopsy |
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What 5 lab tests are done for melanoma?
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1. liver fxn test
2. dermoscopy 3. wood's lamp 4. CBC w/differential 5. pet scan |
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What are the two classifications for staging of melanomas?
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Breslow's classification = vertical thickness in mm
Clark's classification = anatomic level of local invasion on histologic examination |
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What are the 4 levels of Breslow's Classification of melanomas?
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</= 0.75
0.76 - 1.50 1.51 - 4.0 >/= 4.0 |
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What are the 5 levels of Clark's Classification of melanomas?
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Level 1 = lesions involving only epidermis (not invasive)
Level 2 = invasion of papillary dermis, but does nor reach papillary-reticular dermal interface Level 3 = invasion fills and expands the papillary dermis, but does not penetrate the reticular dermis Level 4 = invasion into the reticular dermis but not into the subcutaneous tissue Level 5 = invasion through the reticular dermis into the subq tissue |
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What are 4 methods of management for melanomas?
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1. Excision w/ surgical margins deteremined by depth of tumor invasion
2. Lymph node dissection (controversial) 3. Examination and lab screening for metastasis 4. Txment for metastatic dz usually unsatisfactory |
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What is the most common type of malignant melanoma in general? in blacks?
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Superficial Spreading Melanoma (SSM)
Acrolentiginous (hands, feet, mucosa) in blacks |
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What is Allergic Contact Dermatitis?
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* Delayed hypersensitivity rxn caused by contact w/allergen
* Eczematous dermatitis rxn * Sensitization is required and allergy is specific to a particular chemical |
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What is the management for the Acute stage of Contact Dermatitis?
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1. Stop offending cause
2. Cool wet dressings 3. Oral or IM steroids 4. Antihistamines 5. Antibiotics 6. Topical steroids 7. Topical Immunomodulators - Elidel or Protopic |
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Management for Sub-acute stage of Contact/Eczematous dermatitis
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1. Topical steroids
2. Lubrication/lotions/creams 3. Mild soaps 4. Antihistamines 5. Antibiotics 6. Tar preparations 7. Immunomodulators |
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Management of Chronic stage of Eczematous Dermatitis
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1. Topical steroids
2. Immunomodulators 3. IM steroids 4. Antihistamines 5. Antibiotics 6. Lubrication |
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What are 4 secondary infections often seen with Allergic Contact Dermatitis?
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1. Herpes simplex
2. Eczema herpeticum 3. Molluscum contagiosum 4. Impetigo/cellulitis |
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What are the prodromes of Herpes Simplex Virus?
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itching, burning, tingling, erythema and pain
painful vesicular eruption and crusts |
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What are the triggers for Herpes Simplex?
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fever, stress, immunosuppression, sunlight, cosmetic procedures
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What is Eczema Herpeticum?
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Disseminated herpes simplex
Painful umbilicated pustular vesicles Assoc. w/ malaise and lymphadenopathy Significant morbidity and mortality |
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What is the cause of Molluscum Contagiosum?
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Pox Virus
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Char. of Molluscum Contagiosum
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Dome-shaped papules w/central plug and umbilification
Common in lichenified skin Most common in children, young adults, or immunocompromised patients |
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What causes Warts (Verruca)?
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HPV (human papilloma virus)
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What types of pts are susceptible to Warts?
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Children, young adults, AIDS, atopic dermatitis, lymphoma, people on immunosuppressive drugs
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What are 3 conditions assoc. with HPV?
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Condyloma Acuminatum
Cervical Carcinoma Bowenoid Papulosis |
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What is condyloma acuminatum?
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pale pink papules w/numerous projections on a broad base
usually in rectal or perianal regions |
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Pearly Penile Papules
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Angiofibromas found in 10% of males
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What are the high risk HPV serotypes?
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HPV-16 --> 84% of genital tumors
HPV-18 --> 8% of genital tumors |
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Gardasil protects against which HPV serotypes?
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HPV 6,11,16,18
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How is Condyloma Acuminatum diagnosed?
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Acetic acid test
* 3-5% acetic acid applied directly to lesion * dysplastic, neoplastic tissue will turn white |
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What are the txment options for Condyloma Acuminatum?
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* Podophyllin Resin
* Trichloroacetic Acid (TCA) * Electrosx * Cryosx * Carbon dioxide laser * Interferon a-2b recombinant (Intron A) * topical 5-fluorouracil |
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What is the best txment for Condyloma Acuminatum?
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PREVENTION
* Gardasil vaccine * Safe sex * Hand washing * Screening and PAP smears |
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Impetigo
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* Pustular vesicles w/straw colored discharge
* Thick layer of honey coated crusts |
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What pathogen/bacteria is the most common cause of Impetigo?
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Staph aureus
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What is the txment of Impetigo?
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* Usually self-limiting if non-compromised
* Systemic antibiotic if MRSA occurs * Topical Bactoban 2% --> for superficial MRSA |
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What are the characteristics of Fixed Drug Eruptions?
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100% drug induced
Rash starts in less than 48 hrs Mortality rate = 0 |
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What are the most common drugs that cause fixed drug eruptions?
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* TMP-SMX
* NSAIDS * Tetracyclines * Pseudoepinephrine |
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Stevens-Johnson Syndrome (What is imp. to remember about diagnosing this condition)
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Potentially deadly skin dz that usually results from a drug rxn
* HAS to involve THREE mucuous membranes |
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What is another form of Stevens-Johnson Syndrome?
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Toxic Epidermal Necrolysis
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What are the characteristics of overlapping SJS and TENS?
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* 70-90% drug induced
* Onset of rash = 7-21 days * Mortality rate --> SJS = 5% ; TENS = 30% |
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What are the most common drugs involved in SJS and TENS?
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* Sulfonamides
* Anticonvulsants * NSAIDS * Allopurinol |
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What is the hallmark of TENS?
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Massive keratinocyte apoptosis
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Char. of Discoid Lupus Erythematosis
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Inflammatory skin lesions on face, ears, scalp and other body areas
* permanent scarring and hair loss may occur |
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What type of dz is Dermatomyositis and what are its characteristics?
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* Acquired, idiopathic connective tissue dz
* Proximal muscle weakness, violaceous rash on eyelids, scalp, metacarpophalangeal jnts, and bony prominences |
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What are the characteristic and pathognomic features of Dermatomyositis?
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Periorbital heliotropic rash and Gottron's papules
* pts also present w/photosensitive violaceous eruption, poikiloderma, and periungal telangiectasias |
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Vesicles on the tip of the nose in Herpes Zoster is known as what?
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Hutchingson's sign --> assoc. with ocular complications
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What causes Herpes Zoster (Shingles)?
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Reactivation of varicella virus that entered the cutaneous nerves during an earlier exposure
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Management of Acute Herpes Zoster episode
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Antivirals: Valtrex; Famvir; Acyclovir
Prednisone Anti-Staph antibiotics AT Warm, moist compresses |
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Complications of Herpes Zoster
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Stromal Keratitis
Neurotropic Keratitis Episcleritis/scleritis Iritis Ant. Uveitis Ischemic Papillitis Orbital vasculitis Ocular motor palsy Retinitis Visual loss Postherpetic Neuralgia (70% of cases) |
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Nevus of Ota
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blue-to-gray speckled or mottled coalescing macules or patches affecting forehead, temple, malar or periorbital skin
* may involve mucosa and ocular structures such as sclera, retrobulbar fat, cornea and retina |
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Char. of Nevus of Ota
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Development of glaucoma as high as 10%
Possible malignant degeneration |
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Nevus of Ota presents bilaterally or unilaterally?
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Most cases are unilateral 90%
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Characteristics of Sarcoidosis
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* multi-system granulomatous disorder of unknown etiology
* Involves various organs or tissues * Skin lesions include plaques, papules, subq nodules, nasal and conjunctival mucosal granulomas |
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Ocular manifestations of Sarcoidosis
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* Granulomatous uveitis in 15% of pts
* Usually bilateral * May cause severe vision loss due to: retinal involvement, severe vitreitis, secondary glaucoma * Lacrimal gland enlargement * Conjunctival and eyelid infiltrations * K. sicca |
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Syringomas
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Periorbital tumors
- benign adnexal neoplasm - formed by well-differentiated ductal elements |
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Hydrocystoma
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Cystic lesion of either the apocrine or eccrine sweat glands
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Xanthomas
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Lipid deposits in skin and tendons
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Xanthelasma
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yellowish plaques on eyelids
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Are cholesterol levels high, low or normal in pts with Xanthelasma?
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Cholesterol = normal
LDL and VDRL = high |
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What are the different types of Xanthomas?
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Eruptive
Plane Tendinous Tuberous |
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What are the 3 cutaneous forms of Myiasis?
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1. Superficial infection of larva (maggots)
2. Dermal slowly migrating patch 3. Furuncular form |
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What is the name of the insect found in the skin?
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Dermatobia hominis
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Of the 50 spiders known to bite humans, which 2 cause severe rxns? What types of rxns do they cause?
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Black Widow - neuromuscular abnormalities
Brown Recluse - cutaneous necrosis |
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What is the txment for brown recluse spider bites?
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1. Bite site txed with ice bags and elevation
2. Avoid strenuous exercise 3. Localized heat and immediate sx avoided 4. Antibiotics (erythromycin or cephalosporins) and aspirin given 5. Dapsone may help in severe cutaneous rxns to prevent extensive necrosis 6. Tetanus toxoid given if necessary |
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What can give a more natural appearance than sxical face lift?
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Dermal fillers
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What are 4 examples of Dermal fillers?
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Juvederm
Restylane Radiesse Sculptra |
