plastics questions.txt

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  1. what are risk factors of corticosteroid injections into eyelids
    "skin depigmentation, CRAO, high IOP"
  2. what type of leukemia is most likely to mets to orbit?
    all
  3. whats the most common cause of intraocular lymphoma
    "NHL B-cell type, most commonly part of ""primary CNS lymphoma"""
  4. whats the treatment for intraocular lymphoma
    "radiation, intrvitreal methotrexate or cytosine arabinoside"
  5. "what's the most common type of rhabdomyosarcoma, what quadrant does it present in, and what 10 year survival rate?"
    embryonal; superonasal quadrant; 94%
  6. "what's the most letahl rhabdomyosarcoma, quadrant, and 10 year survival rate?"
    alveolar; lower orbit; 10%
  7. what type of rhabdomysosarcoma is the best survival rate and what is survival rate
    "pleomorphic, 97%"
  8. "when do you do surgery on rhabdo? If you don’t do surgery, how do you treat"
    small and encapsulated; otherwise radiation and chemo
  9. what percent of patietns with ocular melanocytosis get glaucoma? Get uveal melanoma?
    10%; 1/40
  10. what is nevus of ota
    congenital blue nevus that appears in distributino of CN V1
  11. where does mueller's muscle and levator aponeurosis attach to tarsal plate?
    superior border of tarsus; lower one half of anterior part of tarsal plate
  12. what is etiology of majority of hemifacial spasms? How do you treat
    vascular compression of facial nerve in the brainstem; you can treat with neurosurgical decompression
  13. what is the volume of the orbit
    30 mL
  14. what meds most likely cause punctal stenosis
    "chemotherapy meds like docataxel, 5FU, idoxuridine"
  15. how many mm of elevation does muellers muscle give? What neurons activate it? What disease causes a problem with it?
    2 mm; sympathetic nervous system; horners causes 2mm ptosis
  16. what's the sign of levator aponeurosis and why do you see that?
    "high eyelid crease; levator sends attachemnts to skin to create eyelid crease so when it slips, you no longer get that"
  17. what do cocaine and hydroxyamphethamine do to neurons?
    cocaine prevents reuptake of epinephrine; hydroxy forces release of more epinephrine fron non-damaged 3rd order neurons
  18. black discoloration of nasopharnyx should make you suspcious of?
    phycomycosis (most common are mucor and rhizopus)
  19. "what is jones I, II, and III"
    jones I (place fluoresceine in eye and swab nose at 2 and 5 mins) jones II (irrigate the lacrimal system with cannula and swab the nose) jones III (find fluorescien in nose after DCR)
  20. what is lens particle glaucoma
    when lens material is left behind after cataract surgery which then directly clog the TM
  21. what is phacoanaphylactic uveitis
    capsular bag is violated which leads to inflammation
  22. what ecc level should you be worried that corneal endothelium may not survive after sx
    640
  23. what type of cataracts develop in atopic dermatitis
    "shield like anterior subcapsular and less often, PSC (due to steroids)"
  24. what is the term for the amount of surface area of nuclear material in contact with phaco tip
    load
  25. what is the power in phaco terms
    percentage of length that a phaco tip can move relative to the maximal possible length
  26. what is duty cycle
    porportion of time phaco energy is applied during a specified period of time
  27. what is cavitation
    formation of bubbles at phaco tip which leads to lens breakdown
  28. what is the pathophysiology of diabetic cataracts
    "excess of glucose causes activation of sorbitol pathway, sorbitol gets trapped in the lens and creates osmotic gradient for water"
  29. when do you do surgery on a baby with b/l catacts? Unilateral cataracts?
    3 months; 6 weeks
  30. glaucomflecken are caused by?
    high IOP during angle closure glaucoma causes lens epithelial death with resultant opacities
  31. what is tass and how do you manage
    toxic anterior segment syndrome -> sterile inflammatory reaction generally secondary to continaminants (especially from reusuable cannulas) entering the eye or incorrect ph of irrigating solutions -> tap and inject to r/o endolphthalmitis then start steroids
  32. what is the avg anterior-posterior depth of lens at birth and adult
    3.5 mm and 5 mm
  33. what is the size of phaco tip
    1.6mm (so you need to groove 2-3x the phaco tip to crack)
  34. what is the presentation of p acnes
    "chronic infection usually occuring 6 weeks after surgery, typically respond to steroids with apperance of PCO"
  35. whats the best sign or test to see if k edema will resolve after cataract surgery
    peripheral cornea is clear
  36. what are the differences in cataract surgery in 1 month old vs adult
    "you should do posterior capsuolotmy at time of surgery (kids cannot tolerate yag), scleral-corneal tunnel incision (incision is more stable, children will likely rub their eyes), anterior vitrectomy (more likely to have inflammatory response and tendency to form membranes)"
  37. what is bowen's disease
    "squamous cell carcinoma in situ of the skin, usually treated with surgical excision, maybe 5FU"
  38. what structure is analogous to the levator aponeurosis in the upper lid? What is it?
    "capsulopalpebral fascia, which originates from muscle fibers of inferior rectus, extends forward, wraps around inferior oblique and then inserts into the inferior tarsal border"
  39. describe bick procedure
    direct resection and then repair of the lower eyelid margin just before the lateral canthal angle -> this traction causes rounding of the lateral canthal angle
  40. describe lateral tarsel strip
    "shortening the lower eyelid and then suturing it to the periosteum, which maintains the sharp lateral canthal angle"
  41. describe the medial spindle procedure
    removing a diamond shaped piece of conjunctiva and lower lid retractors 4mm inferior to the inferior canaliciuls and then putting in everting sutures to correct medial entropion
  42. describe cutler-beard procedure
    "used to correct upper eyelid defects > 50% of the margin, lower eyelid full thickness flap is advanced into the upper eyelid defect, allowed to vasculiarize for 6 weeks and then upper and lower eyelids separated (mneumonic: CUT from Lower (beard)"
  43. "for dermatocholasis repair, what is the pinch method and how much skin do you want to leave behind"
    "put forceps in lid crease, pinch the excess skin between lid crease and margin until the eyelashes start to evert; as a rule of thumb, leave 10mm from the incision to the brow and 10 mm from incision to margin"
  44. is the levator elevation affected in ptosis 2/2 aponeurosis
    no
  45. what is the risk of melanoma if blue nevi affecting the eye
    1/400
  46. how does metastatic cancer affect the orbit
    associated with bone erosion and expansion of the orbit -> enolphthalmos
  47. what valve seperates lacrimal sac to common canaliculus
    valve of rosenmuller
  48. what is the location of venous drainage of lateral pretarsal eyelid tissues
    superficial temporal veins
  49. what is the normal configuration of the lateral canthal tendon insertion in relation to medial canthal tendon insertion
    lateral inserts 2mm superior to medial (important for doing lateral tarsal strips)
  50. what is the ideal candidate for fasanella-sevat procedure (tarsoconjunctival mullerectomy)
    mild amount of ptosis
  51. what muscles are responsible for involuntary blinking? Forced eyelid closure? Vertical wrinkles between eyebrows? Horizontal wrinkles inferior to heads of eyebrows?
    pretarsal part of obicularis; orbital part of oblicularis; corrugators (mneumonic: corrugated roofs have vertical wrinkles); procerus
  52. what are lengths of vertical canaliculus? Horizontal canaliculus? Nasolacrimal sac? Nasolacrimal duct?
    2mm; 8-10mm; 12-15mm; 12mm
  53. what are side effects of tensilon test and what can you give to prevent it?
    heart block; atropine
  54. describe tenzel procedure
    "aka tarsal fracture operation -> make posterior horizontal tarsal incision 2mm inferior to the eyelid margin, eyelid margin rotated away from the eye and stabilized with everting sutures "
  55. which part of the lacrimal gland should you only biopsy and why
    "orbital part; the ductules that empty the lacrimal gland pass through palpepbral part, so if scarring occurs when biopsying the palpebral part can cause DES"
  56. what is epiblepharon? Ankyloblepharon? Euryblepharon?
    when pretarsal skin and obic override margin; partial failure of eyelid to complete developmental seperation with residual strands of tissue connecting the eyelids; lengthening of the horizontal palpebral fissure and generally involves lower lateral eyelid
  57. what percent of NLDO clear in first year of life
    70-90%; treat with massages and topical abx
  58. what is a low grade squamous cell carcinoma? Premalignant lesion that can lead to SCC
    keratoacanthoma; actinic keratosis
  59. how do you repair defect < 33% of the lid? 33-50% of the lid? > 50% of upper lid and lower lid?
    "1. direct closure 2. eyelid can be freed with lateral canthotomy and semicircular flap is rotated into the defect; 3. upper eyelid- cutler beard procedure, lower eyelid- modified hughes procedure"
  60. what is modified hughes procedure
    upper eyelid flap of conj and tarsus are sewen into the lower eyelid posterior lamellae and the anterior lamellae is filled in with free skin graft
  61. what do you have increased risk of with b/l retinoblastoma s/p radiation
    "osteosarcoma, chondrosarcoma, fibrosarcoma"
  62. what is epicanthus inversus? Epicanthus tarsalis? Epicanthus supraciliaris? Epicanthus palpebrus?
    1. medial eyelid skin fold that is more prominent in the lower eyelid (inferior) 2. medial eyelid skin fold more prominent in upper eyelid (tarsus) 3. medial eyelid skin fold more prominent from the eyebrow to the lacrimal sac (above the cilius) 4. medial eyelid skin fold equally prominent in teh upper and lower lid (equal in palpebrae)
  63. what is CI in laser skin resurfacing and why?
    accutane (isoretinoin) because it causes delayed epithelial healing -> scarring
  64. "if you have orbital cellulitis and high IgE, what organism?"
    aspergillus
  65. what causes vascular congestion at the rectus muscle insertions? Conjunctival vascular congestion?
    TRO; dural shunt
  66. what is the location of superior orbital fissure
    between the greater and lesser wings of sphenoid
  67. what is the annulus of zinn
    circle overlying the superior orbital fissure and divides it into 2
  68. what nerves are inside the annulus of zinn? Which outside
    "inside: III, VI, V1 (nasociliary branch); outside: V1 (lacrimal and frontal branches), IV, sup ophthalmic vein (mneumo: LFT + sup ophthalmic vein)"
  69. what is myotomy
    incomplete horizontal incisions in the muscle to weaken and lengthen in
  70. what should you first treat sympotomatic hyperthryoids with?
    beta blockers
  71. what is the first line treatment for hyperthyroidism and how does it work
    methimazole and PTU (inhibits the addition of iodine to thyroglobulin by the enzyme TPO)
  72. how many fat pads in the upper eyelids? Lower lids?
    2 and 3
  73. why is mri better for tumors
    "xray is readily absorbed by bone but in MRI, you can see soft tissue well because it's not being absorbed by bone"
  74. what is the site of most common presentatin of orbital lymphoma
    "lacrimal fossa (the one in the frontal bone, not the one housing lacrimal sac)"
  75. what is the most prognostic in terms of survival of eyelid melanoma
    "tumor thickness, tumors > 4mm means <50% survival at 5 years, you should do sentinel lymph node biopsy for eyelids >1mm thick"
  76. what can cause a mass superior and medial to the medial canthus?
    "herniation of neurological tissues (meningocele, encephalocele, meningoencephlocele), dacryocystocele presents inferior and medial to the medial canthal tendon"
  77. what type of bacterial is actinomycoses
    filamentous gram positive rod
  78. what is most common orbital mets in men
    lung
  79. what is gray line
    muscle of riolan
  80. where do tissue from medial pretarsal tissue drain? Temporal pretarsal tissue? Post-tarsal tissue?
    "angular vein; superficial temporal vein; orbital veins, deeper branchers of the anterior facial vein, and pterygoid plexus"
  81. what is another name for area of superior orbital fissue inside annulus of zinn
    oculomotor foramen
  82. where are krause glands found? Gland of wolfring?
    "fornices, non-marginal tarsal border"
  83. what is axial displacement? What is ddx of axial displacement?
    "globe pushed straight out; cavernous hemangiomas, AV fistulas, meningioma, glioma, muscle cone tumor"
  84. what are differences between congenital ptosis when looking down and presence of lag between involutional ptosis and why do you get that difference
    "in congenital ptosis, the ptotic lid is higher when looking downgaze and rarely get lagophthalmos because the muscle belly is fibrous and fatty and this extra bulk can prevent it from moving down and from closing "
  85. what is management for keratoacanthoma
    incisional biopsy
  86. pagetoid spread of sebaceous cell carcinoma can mimic what
    papillary palpebral conjunctiitis
  87. what is pagetoid spread of sebaceous cell carcinoma
    "occurs intraepidermally, whereby cells proliferate singly or in nests at all levels of epidermis"
  88. what is management for sebaceous cell carcinoma
    excision with sentinel lymph node biopsy
  89. what stain will identify sebaceous cell carcinoma and what does it look like on path
    tumor cells appear vacuolated due to the fat/lipid that is removed by alcohol during processing
  90. what is the weakest part of the maxillary bone
    posterior medial
  91. what functions do the orbital portion and the pretarsal/preseptal obic perform? What nerve is responsible
    voluntary eyelid closure (squeezing); unconscious blinking; innervated by CN VII
  92. what are the eyelid protractor muscles
    "obicularis, procerus, corrugator superciliaris"
  93. what type of nevus has most malignant potential?: least malignant
    junctional; intradermal
  94. when would you do probing in a dacryocystocele
    if digital compression fails to resolve it in 1-2 weeks
  95. what eyelid procedure is most likely to result in visual loss
    lower lid blepharoplasty associated with retrobulbar hemorrahge
  96. what surgery do you do if someone is born without canalciular system and puncta
    cDCR (conjunctivodacryocystorhinostomy)
  97. what artery do you have to avoid on initial incision for DCR
    angular artery
  98. how do you distinguish choroidal artery occulsions from CRAO
    choroidal artery occulsions you get no perfusion of short posterior ciliary arteries so you get no choroidal flush
  99. what artery does angular artery arise from
    "facial artery, which comes from external carotid artery circulation (not ophthlamic artery, which branches from internal carotid)"
  100. how do you send specimen to lab for salmon plaque in conjunctiva? What path tests?
    fresh tissue without preservatives to get flow cytometry and cell surface markers
  101. what percentage of hyperthyroids get TRO? What percentage of TRO has high thyroid? Euthyroid?
    "30%; 90% have high thyroid, 6% euthyroid, 3% have hashimotos 1% have primary hypothyroidism"
  102. meibomian glands secrete by what mechanism? Lacrimal glands? Glands of moll? Glands of krause/wolfring?
    "holocrine, exocrine, apocrine (Molly is a sweaty Ape), exocrine"
  103. "what is holocrine, exocrine and apocrine?"
    cells produce the product in the cytoplasm and release the product into the lumen of the gland duct by disruption of cellular membranes thereby destroying the cell releasing the product; exocrine glands releae aqueous; apocrine glands secrete via a merocrine mechanism like sweat glands -> decapitation secretion
  104. where are glands of krause located?
    inferior fornix (jerry KRAUSE is a lowlife hiding in the bottom)
  105. "lesion causing proptosis in a kid that acutely enlarges, also history of increasing with URI…what is the mechanism"
    lymphangioma; spontaneous hemorrhage intralesionally (lymphatic component can be deduced by history of enlarging with URIs)
  106. which muscles don’t contribute to annulus of zinn
    "levator, Inf oblique, sup oblique"
  107. what is the order of tissue going from superficial to deep in the upper face
    "skin and subcutaneous tissue, temporoparietal fascia (SMAS), loose areolar tissue, deep temporal fascia, temporalis muscle"
  108. what is the difference between nevus and freckle?
    "nevus is from undifferentiated melanocytes found at the epidermal/dermal border, freckle is from melanocytes producing too much pigment"
  109. whats the ddx for optociliary shunt vessels?
    "sphenoid wing meningioma, optic nerve sheath meningioma (most likely), low grade optic glioma, chronic papilledema, chronic glaucoma, old CRVO"
  110. what causes optociliary shunt vessels
    "like varices and hemorrhoids, anything that prevents chronic poor drainage of the central retinal vein"
  111. what is the most common cause of congenital ptosis
    myogenic; poor development of levator muscle
  112. where are glands of wolfring found?
    non-marginal tarsal border
  113. what glands produce reflex tears
    "lacrimal gland, glands of wolfring and krause"
  114. what structure is 8mm medial to medial canthal tendon
    angular artery and vein
  115. what are 4 signs of disinsertion of lower eyelid retractors (with retraction into the orbit)
    "deepening of the lower fornix, ptosis of the lower lid, white subconjunctival line below the tarsus, little movement of the lower eyelid with downgaze"
  116. what test should you order for MG patients
    "TSH (10% have thymomas, and removing thymoma can improve function)"
  117. lymphoproliferative lesions arisign from what structure gives highest risk of systemic non-hodgkins lymphoma
    eyelid
  118. what structures pass through inferior orbital fissure
    "maxillary branch of CN V, inferior ophthalmic vein"
  119. what location does sebaceous cell caricnoma most commonly present and why
    upper eyelid ; sebaceous cell is cancer of meibomian glands and zeis glands which are more common in upper lid
  120. what percntage of ON gliomas associated with NF1
    25-50%
  121. when is surgery/chemo/radiation indicated in ON glioma
    "when lesions aproach the chiasm (surgery), when lesions invade the chiasm (surgery/chemo)"
  122. what is the most common type of ON glioma in children
    juvenile pilocytic (hairlike) astrocytoma
  123. whats the thinnest bones of orbit
    ethymoid and maxillary
  124. what does Withnall's ligament do
    changes direction of levators force from anterior posterior to superior inferior
  125. what structure divides the lacrimal gland into orbital and palpebral lobes
    levator
  126. what are indications to give beta blockers for capillary hemangioma vs observation
    "obstructing visual axis, induces refractive error"
  127. what characteristics distinguish capillary hemangioma from rhabdo
    "slow growing lesion, no ecchymosis typical for capillary hemangioma"
  128. how do you distniguish epidermal inclusion cyst vs apocrine hidrocystoma
    EIC has central pore and filled with keratin while hidrocystoma is smooth and filled with fluid
  129. what does clear vs mucopurulent discharge and tearing from a infant tell you
    "clear tearing is caused by obstruction of upper system: puncta, canaliculus, common canaliculus while mucopurulent discharge is caused by NLDO"
  130. how does botox work
    prevents release of acetylcholine into neuromuscular junction
  131. what are signs of tumor of lacrimal sac? What are most common tumors of lacrimal sac?
    enlargment of lacrimal sac above medial canthus tendon and bloody discharge; squamous cell papillomas and carcinomas
  132. "what 2 findings will reasure you that you have IOI and not infection, mets, ruptured dermal cyst so you don't have to do biopsy and systemic workup?"
    normal CBC and muscle tendon inflammation
  133. whats the difference in asian vs caucasion eyelids?
    "lower insertion of levator to septum; in asians, the septum fuses with the levator between the superior border of the tarsal plate and the eyelid margin whereas in caucasians the septum fuses with the levator 2-5mm above the tarsal plate, allowing more fat to occupy a higher position than in asians"
  134. how many meibomian glands occupy upper vs lower eyelids
    25-40; 20-30
  135. "old man hears swishing sound in his eye and you can auscultate a bruit, what is it?"
    carotid cavernous fistua
  136. at what week do you notice congenital NLDO? Why?
    6 weeks; lacrimal gland become fully formed and functions at 6 weeks
  137. when are first tears made?
    20 days after birth (contradiction with 6 weeks when lacrimal gland formed?)
  138. what size cuts is head CT:? Orbital CT?
    5mm cuts/3mm cuts
  139. when should you do anterior incision for chalazion?
    if you suspect it involves mainly skin and obicularis (tarsus appears normal)
  140. what is silent sinus syndrome?
    due to hypoventilation of the maxillary sinus from obstructino of ostiomeatal complex -> chronic subclinical inflammation which things the maxillary bone -> collpase of maxillary sinus and displacement of orbital globe downward
  141. what is treatmetn for silent sinus syndrome?
    releaving the ostial occlusion and reconstructino of orbital floor
  142. what causes the optic neuropathy and APD in retrobulbar hemorrhage
    compression of the posterior ciliary arteries (more compressible than central retinal artery)
  143. what is the least common site for basal cell carcinoma
    lateral canthus (most common is lesions of lower eyelid > medial canthus > upper eyelid > lateral canthus= mneumo: IMSL im slow)
  144. what is the length of orbital part of optic nerve? Length from posterior globe to orbital foramen?
    25 mm/ 18 mm
  145. what bones are located in medial wall
    "mneumo: SMEL (sphenoid lesser wing, maxillary, ethymoid, lacrimal)"
  146. what bones are associated with roof
    front less- frontal bone and lesser wing of sphenoid
  147. what bones are associated with floor
    "maxillary, zygomatic, palatine"
  148. what bones are located in lateral wall
    zygomatic and greater wing of sphenoid
  149. how tall is the tarsus in upper lid and lower lid
    "upper lid 10-12mm, lower lid 4mm"
  150. how much more likely are hyperthyhroid smokers more likely to get TRO
    7x
  151. whats the shortest orbital wall
    floor
  152. wahts the most common benign orbtial tumor in adults
    capillary hemangioma
  153. what is the layers of the eyelid going from skin backwards above the tarsus
    "skin, obicularis, septum, orbital fat, levator, muller's muscle conjunctiva"
  154. what retraction pattern do you see in TRO to distinguish it from other causes of retraction
    lateral retraction worse than medial retraction (lateral flare)
  155. where does a cDCR start and end?
    "caruncle, middle meatus"
  156. what are the responsibilities of the anterior and posterior medial canthus tendon
    anterior tendon resopnsbiel for structural support of eyelid; posterior tendon responsible for keeping the eyelid and punctum apposed to the globe
  157. why is p+I indicated in children with dacryocytitis but not adults
    suspicion of obstruction at valve of Hasner (valve between nasolacrimal duc and inferior meatus) in children
  158. "what is the diagnosis of kid with proptosis, ecchymotic lid, and horners"
    neuroblastoma
  159. from what does orbital septum arise
    periosteum
  160. where is the supraorbital notch
    orbital roof
  161. "what can cause unilateral conjunctivitis, glaucoma x 2 years and dilatd super opthalmic vein"
    low flow dural cavernous fistula
  162. what type of entropion do you get with tightening of obicularis
    spastic entropion
  163. what are 3 main causes of involutional entropion
    "horizaontal lengthening of the eyelid, eyelid retractor disinsertion, over-riding obicularis"
  164. what causes cicatricial ectropion
    shortened anterior lamellae causing traction on the lower eyelid
  165. what structure is found between muller's muscle and the levator palpebrae superiorus
    peripheral anterial arcade
  166. what is the capsulopalpebral fascia
    "it is simlar to levator in upperlid, originals from inferior rectus, extends forward and wraps around inferior oblique and then inserts into inferior tarsal border"
  167. what foramen do the branches of CN V go through
    "Standing Room Only (V1 goes through superior orbital fissure, V2 foramen rotundum V3 foramen ovale"
  168. what anatomical consideration should you know when doing lower blepharoplasty
    inferior oblique sepearates medial and central fat pads
  169. acetylchonine receptor antibody is present in what percent of MG patients? OMG patients
    90%; 70%
  170. what bone does optic canal reside
    lesser wing of sphenoid
  171. what layer do meningiomas arise
    arachnoid villi
  172. what is leser-trelat sign
    sudden onset of multilpe seborrheic keratoses; asosciated with GI adenocarcinoma
  173. what is the most common primary malignancy of lacrimal sac
    squamous cell carcinoma
  174. what are presenting symptoms of squamous cell carcinoma of lacrimal sac
    "chronic dacryocystitis, epiphora"
  175. what are sigsn that a deacryocystistis might really be cancer
    bloody tears and regional lymphadenopathy
  176. describe anatomy of medial canthal tendon going from lateral to medial
    upper and lower limb fuse -> tendon splits into anterior and posterior limb which goes around the lacrimal sac and fuses onto the anterior and posterior lacrimal crest respectively
  177. what mnaterial is used in prosthetic implants and allows ingrowth of tissue and enhanced motility
    "hydroxyapatite, has tiny pores so soft tissue can grow in"
  178. how many people don’t have common cannaliculus
    10%
  179. what is length of lacrimal sac? nasolacrimal duct?
    "10mm, 15-18mm"
  180. what is most common tumor invading the orbital
    squamous cell carcinoma (usually arising in maxillary sinus)
  181. what is the length of the lacrimal sac and lacrimal duct?
    12-15mm; 12mm
  182. what is the anatomical relationship between common canaliculus and medial canthal tendon
    posterior to anterior portion of medial canthal tendon
  183. what is the most common etiology for congenital ptosis
    myogenic; poor development of levator muscle

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