Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
94 Cards in this Set
- Front
- Back
|
T/F - Rosacea involves P. acnes activity.
|
False - P. acnes and other microbes not active in rosacea.
|
|
|
T/F - Cold temperatures can result in facial flushing in Rosacea.
|
True - both extremes (warm or cold) can result in flushing
|
|
|
Facial rosacea appears first in __%
Ocular rosacea first in __% Both in __% |
55%, 20%, 25%
|
|
|
T/F - According to the manual in the lids section, facial rosacea is __ more frequent in (men/women), but more severe in (men/women).
|
2X, more freq in women, men more severe
|
|
|
What stage of rosacea involves only the "ruddy complexion?"
|
Mild
|
|
|
What stage of rosacea involves the papular/pustular lesions?
|
Moderate
|
|
|
What stage of rosacea involves the overgrowth of sebaceous and connective tissue of the nose?
|
Severe
|
|
|
Can rosacea involve the cornea?
|
Yes but uncommon to rare
|
|
|
Can rosacea involve anterior uveitis?
|
Yes but very uncommon
|
|
|
T/F - Teleangiectatic vessels can occur both on the lids and nose in rosacea.
|
True
|
|
|
Name the nine corneal manifestations of ocular rosacea in decreasing frequency.
|
1. Peripheral SPK
2. Superficial pannus 3. Neovascularization 4. Epithelial edema 5. Microcysts 6. Peripheral EBMD 7. Ill-defined SEIs (peripheral) 8. Peripheral to diffuse anterior stromal infiltration and hazing, often triangular in shape when near limbus 9. Peripheral corneal thinning |
|
|
How do you treat facial rosacea?
|
Peeling agents, Tetracycline, Isotretinoin (Accutane - not FDA approved), Metro-gel
|
|
|
How do you Tx ocular rosacea?
|
Tx chalazia, hordeola, meibomitis, blepharitis; artificial tears; mild steroid for peripheral keratitis; Tetracycline PO
|
|
|
What condition would you use Tretinoin (Retin-A) for?
|
Rosacea, Actinic Keratoses, Periorbital comedones
|
|
|
How do you use Tretinoin (Retin-A)? What are its risks?
|
Topical, QHS ONLY; risk of sunburn; avoid using peeling agents, drying soaps, cosmetics, astringents. Results in redness/peeling, exacerbation of deeper lesions.
|
|
|
How long before you see Retinoid Tx results?
|
2-6 weeks
|
|
|
How does Retinoid Tx work?
|
Decreases cohesiveness of follicular epithelial cells, reducing comedo formation; stimulates cell mitosis and turnover.
|
|
|
How does Accutane (Isotretonin) work?
|
Inhibits sebaceous gland function and keratinization.
|
|
|
____ is used for obstructive acne.
____ is used for cystic acne. |
Retinoid Tx = obstructive
Isotretinoin (Accutane) = cystic |
|
|
What are the side effects of Accutane (Isotretinoin)?
|
Chelitis (90-95%), Conjunctivitis (40%), Musculoskeletal complaints, dry skin/mouth/nose/eyes, corneal opacities (7%), pseudotumor cerebri, decreased night vision (pupil dilation), lipid disorders, elevated ESR
|
|
|
A 24 y/o female complains of major acne problems, repeated styes, and irritated, red eyes. She thinks it may be related to the stress from her pregnancy. What should you use to treat her? How about Accutane?
|
Manual does not show how to treat pregnant Rosacea pts, BUT DO NOT USE ACCUTANE! It is an ABSOLUTE contraindication.
|
|
|
What is the causative agent of molluscum contagiosum?
|
Pox virus
|
|
|
T/F - Molluscum contagiosum is typically in children.
|
True
|
|
|
Your 11 year-old patient has a nodule on the lid that is small, grey-white, with a central light colored core. It looks like it's filled with a cheesy material; she said it has been there for several months. What's going on?
|
Molluscum contagiosum
|
|
|
How do you DDx a keratoacanthoma from a molluscum?
|
Keratoacanthoma is larger and is more quickly progressive (molluscum grows at a slow rate).
|
|
|
T/F - Molluscum contagiosum often resolves spontaneously.
|
True
|
|
|
What are the initial Sx of Chicken Pox?
|
Fever, malaise, myalgia, itchy maculopapular rash (turns into vesicles/pustules LATER)
|
|
|
Name the ocular manifestations of Chicken Pox.
|
Phlyctenule on lids, conj, limbus; excavated ulcers on lids; SPK, shallow corneal ulcer
|
|
|
How do you Tx varicella?
|
Supportive Tx (drying/cooling derm preparations), prophylactic AB ung on lesions, oral antihistamine to reduce itch, prophylactic AB for cornea, oral acyclovir
|
|
|
What area is most often affected by Herpes Zoster?
|
Thoracic region (55%)
|
|
|
Name the three ophthalmic divisions of the trigeminal (CN V).
|
Frontal, Lacrimal, Nasociliary
|
|
|
What are the divisions of the frontal division of the ophthalmic division of CN V?
|
Supraorbital, supratrochlear
|
|
|
What are the divisions of the nasociliary division of the ophthalmic division of CN V?
|
"LINE" = Long ciliary, Infratrochlear, Nasal, posterior Ethmoidal
|
|
|
T/F - Neoplasia can activate HZV.
|
True
|
|
|
T/F - HIV can activate HZV.
|
True
|
|
|
T/F - Corticosteroids can activate HZV.
|
True
|
|
|
In HSV, prodrome then (pain/tingling) occurs first.
|
Pain first 1-2 days after prodrome, then tingling (hyperesthesia) 2-3 days after prodrome
|
|
|
T/F - HSV starts at the lids then moves up to the scalp.
|
False - moves down from scalp then to lids
|
|
|
What is Hutchinson's Sign?
|
Involvement of HSV at tip of nose or side of tip of nose; 75% pts have ocular involvement if positive, 25% ocular involvement if negative.
|
|
|
Your patient has a positive Hutchinson's sign. What should you do next?
|
Aggressive corneal Tx of HSV within 48 hrs.
|
|
|
Can you use acyclovir for HZV?
|
Yes, 800 mg PO 5x/day. Can also use Famciclovir or Valtrex.
|
|
|
Can you use steroids for HZV?
|
Yes, oral steroids.
|
|
|
What is Capsaicin used for?
|
Post-herpetic neuralgia in HZV.
|
|
|
Primary herpes simplex is often seen in what age range?
|
infants (not younger than 6 mos), young children, teenagers
|
|
|
What percentage of patients with HSV have reactivated virus?
|
25%
|
|
|
T/F - Infectious disease and/or surgery can reactivate HSV.
|
True
|
|
|
By age 5, __% are infected with HSV, and by age 15, __%
|
60%, 90%
|
|
|
T/F - Follicular conjunctivitis is possible with HSV.
|
True (rare)
|
|
|
Does HSV respect the midline?
|
No, HZV respects the midline however
|
|
|
How do you treat primary HSV?
|
Generally non-specific Tx, no definitive Tx since lesions self-limiting. Can use topical acyclovir over mildly debrided lesions. Oral acyclovir only if very severe.
|
|
|
T/F - You should always treat primary HSV with oral acyclovir.
|
False - only if severe.
|
|
|
Urticaria and Angioneurotic Edema are Type __ hypersensitivity rxns, aka ____.
|
Type I, immediate
|
|
|
Type I allergy in general caused by...
|
1. Insect bites, bee stings
2. Food allergies 3. Meds 4. Inhalants (mold, dust, pollen) 5. Ingestants (artificial colors, preservatives) |
|
|
Your patient presents with smooth, slightly elevated patches (wheals), much redder than the surrounding skin; underlying tissue is normal and not swollen. The patient complains of itching. What is this?
|
Urticaria (hives)
|
|
|
Your patient presents with edema in the deep tissue but superficial skin is normal. The area is very itchy. What do you suspect?
|
Angioneurotic edema
|
|
|
What oral allergy med has the highest specificity for the eye?
|
Chlortrimeton
|
|
|
What oral allergy med works the fastest?
|
1st generation (Benadryl)
|
|
|
Use (warm/cold) compress first, then (warm/cold) compress after for type I allergy?
|
Cold in first 24h, then warm packs in subsequent days.
|
|
|
How soon should you follow up with your type 1 allergy patient?
|
Severe = next day
Moderate = 2-3 days Mild = 3-5 days or PRN |
|
|
Contact dermatitis is a Type __ hypersensitivity rxn, aka _____ hypersensitivity.
|
Type IV, delayed
|
|
|
For sensitization, a strong allergen in Type IV allergy takes a time period of ___, and a weak allergen takes ___.
|
5-10 days for strong
months to years for weak |
|
|
When re-exposed to a Type IV allergen, it takes ___ hours to see reaction.
|
12-72 hours
|
|
|
What are possible allergens for Type IV allergy?
|
Topical meds (neomycin), cosmetic preservatives, rubber, acrylics, plants, formaldehyde, nickel, Paraben, PPDA, "caine" preparations, balsam of Peru
|
|
|
The Skin Test is for Type __ allergy, and the Patch Test is for Type __ allergy.
|
Type I (1 hr rxn), Type IV (24h rxn)
|
|
|
What is the RAST?
|
Radio-allergosorbent test, for systematic allergy testing.
|
|
|
T/F - Always use Burow's soln for Type IV allergies.
|
False - ONLY for acute presentations
|
|
|
What can you use Elidel or Protopic for?
|
These are Cytokine inhibitors used for Type IV allergy
|
|
|
Can you use steroids for Type IV allergy?
|
Yes, for very severe cases (poison oak, etc) - use steroids PO or IM
|
|
|
Can you use oral antihistamines for both Type I and Type IV allergies?
|
Yes, same regimen too
|
|
|
Use skin moisturizer in (acute/chronic) Type IV allergy, and Burrow's in (acute/chronic) Type IV allergy.
|
Chronic = moisturizers (NO astringent)
Acute = Burrow's |
|
|
What is the causative agent of Demodex?
|
Mites
|
|
|
Demodex folliculorum reside in ___, and Demodex brevis reside in ___.
|
Folliculorum = hair and eyelash follicles
Brevis = sebaceous glands |
|
|
T/F - Virtually all adults over age 50 are infested with lice.
|
False - MITES (demodex) not lice (phthiriasis)
|
|
|
Describe demodex folliculorum behavior.
|
Sexually active in dark (scared of bright light and hide in follicle), copulate on lid margin, females lay eggs in follicle, life span ~14 days.
|
|
|
What kinds of eyelash signs do you see in Demodex?
|
Brittle (possibly thickened) lashes that easily fall off/break, pyramidal follicles from edema, mites, eggs
|
|
|
What condition is characteristic of collarettes?
|
Collarette = thin sleeve at base of lash, seen in Demodex
|
|
|
T/F - Can have corneal irritation in Demodex.
|
True - from misdirected lashes
|
|
|
When is the itching worst for Demodex?
|
Night or dim light, worse in warm weather
|
|
|
How do you Tx demodex in office?
|
Anesthetize lid, lure mites to surface, wait 5 min, brush alcohol on lid surface (avoid cornea), repeat once a week for 3 weeks
|
|
|
How do you Tx demodex at home? For how long?
|
Lid hygeine QAM and QHS, copious ointment, clean off all ointment next morning; takes 3-4 weeks for response.
|
|
|
What type of louse is most commonly found in the lids?
|
Pubic louse (Phthirus pubis); infrequently Pediculus capitis (head louse)
|
|
|
T/F - Phthirasis can be asymptomatic.
|
True - range from asymptomatic to intense itching
|
|
|
What causes the irritation in Phthirasis?
|
Secreted saliva, digestive juices, and excreta of louse
|
|
|
What do you call lice on a bald man's head?
|
Homeless.
|
|
|
With slit lamp evaluation you see tiny gray-white nodules on the lids/lashes. There is also dark red crusting. You also note a palpable pre-auricular node. What do you suspect?
|
Possible Phthiriasis Palpebrum. Gray-white shells = Nits (ova). Dark red crusting = mixture of blood and feces.
|
|
|
What is Kwell (Gamma benzone hexachloride/lindane) used for?
|
Phthiriasis - NOT used on lids, toxic to eye; use for body/pubic area only.
|
|
|
What is Rid (Pyrethrin) used for?
|
Phthiriasis - NOT used on lids, toxic to eye; use for body/pubic area only.
|
|
|
What is A-200 Pyrinate (Pyrethrin) used for?
|
Phthiriasis - NOT used on lids, toxic to eye; use for body/pubic area only.
|
|
|
What is Nix (Permethrin) used for?
|
Phthiriasis - NOT used on lids, toxic to eye; use for body/pubic area only.
|
|
|
How do you Tx Phthiriasis?
|
Tx concomitant pelvic/head lice - generally one shampooing, but recommend two shampooings over two weeks.
Lid Tx - remove nits/lice w/ forceps, smother lice/nits with ung |
|
|
Which of the following below is NOT appropriate for Phthiriasis Palpebrum:
1. Bland ung 2. Yellow mercuric oxide 3. AB ophthalmic ung 4. Physostigmine 5. Fluoroscein 6. Kwell |
The following are too toxic:
4. Physostigmine 6. Kwell |
|
|
How long to Tx Phthiriasis?
|
Two weeks, then recheck for nits.
|
|
|
T/F - Primary HSV lesions leave scars.
|
False - they do NOT leave scars
|
|
|
T/F - You must tweeze out the mites before you apply any ointment.
|
FALSE - treatment of demodex does not involve tweezing out the mites (kill mites with 70% alcohol soln after anesthetize w/ proparacaine)
|
