plastics questions.txt

"skin depigmentation, CRAO, high IOP"

all

"NHL B-cell type, most commonly part of ""primary CNS lymphoma"""

"radiation, intrvitreal methotrexate or cytosine arabinoside"

embryonal; superonasal quadrant; 94%

alveolar; lower orbit; 10%

"pleomorphic, 97%"

small and encapsulated; otherwise radiation and chemo

10%; 1/40

congenital blue nevus that appears in distributino of CN V1

superior border of tarsus; lower one half of anterior part of tarsal plate

vascular compression of facial nerve in the brainstem; you can treat with neurosurgical decompression

30 mL

"chemotherapy meds like docataxel, 5FU, idoxuridine"

2 mm; sympathetic nervous system; horners causes 2mm ptosis

"high eyelid crease; levator sends attachemnts to skin to create eyelid crease so when it slips, you no longer get that"

cocaine prevents reuptake of epinephrine; hydroxy forces release of more epinephrine fron non-damaged 3rd order neurons

phycomycosis (most common are mucor and rhizopus)

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)

when lens material is left behind after cataract surgery which then directly clog the TM

capsular bag is violated which leads to inflammation

640

"shield like anterior subcapsular and less often, PSC (due to steroids)"

load

percentage of length that a phaco tip can move relative to the maximal possible length

porportion of time phaco energy is applied during a specified period of time

formation of bubbles at phaco tip which leads to lens breakdown

"excess of glucose causes activation of sorbitol pathway, sorbitol gets trapped in the lens and creates osmotic gradient for water"

3 months; 6 weeks

high IOP during angle closure glaucoma causes lens epithelial death with resultant opacities

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

3.5 mm and 5 mm

1.6mm (so you need to groove 2-3x the phaco tip to crack)

"chronic infection usually occuring 6 weeks after surgery, typically respond to steroids with apperance of PCO"

peripheral cornea is clear

"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)"

"squamous cell carcinoma in situ of the skin, usually treated with surgical excision, maybe 5FU"

"capsulopalpebral fascia, which originates from muscle fibers of inferior rectus, extends forward, wraps around inferior oblique and then inserts into the inferior tarsal border"

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

"shortening the lower eyelid and then suturing it to the periosteum, which maintains the sharp lateral canthal angle"

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

"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)"

"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"

no

1/400

associated with bone erosion and expansion of the orbit -> enolphthalmos

valve of rosenmuller

superficial temporal veins

lateral inserts 2mm superior to medial (important for doing lateral tarsal strips)

mild amount of ptosis

pretarsal part of obicularis; orbital part of oblicularis; corrugators (mneumonic: corrugated roofs have vertical wrinkles); procerus

2mm; 8-10mm; 12-15mm; 12mm

heart block; atropine

"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 "

"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"

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

70-90%; treat with massages and topical abx

keratoacanthoma; actinic keratosis

"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"

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

"osteosarcoma, chondrosarcoma, fibrosarcoma"

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)

accutane (isoretinoin) because it causes delayed epithelial healing -> scarring

aspergillus

TRO; dural shunt

between the greater and lesser wings of sphenoid

circle overlying the superior orbital fissure and divides it into 2

"inside: III, VI, V1 (nasociliary branch); outside: V1 (lacrimal and frontal branches), IV, sup ophthalmic vein (mneumo: LFT + sup ophthalmic vein)"

incomplete horizontal incisions in the muscle to weaken and lengthen in

beta blockers

methimazole and PTU (inhibits the addition of iodine to thyroglobulin by the enzyme TPO)

2 and 3

"xray is readily absorbed by bone but in MRI, you can see soft tissue well because it's not being absorbed by bone"

"lacrimal fossa (the one in the frontal bone, not the one housing lacrimal sac)"

"tumor thickness, tumors > 4mm means <50% survival at 5 years, you should do sentinel lymph node biopsy for eyelids >1mm thick"

"herniation of neurological tissues (meningocele, encephalocele, meningoencephlocele), dacryocystocele presents inferior and medial to the medial canthal tendon"

filamentous gram positive rod

lung

muscle of riolan

"angular vein; superficial temporal vein; orbital veins, deeper branchers of the anterior facial vein, and pterygoid plexus"

oculomotor foramen

"fornices, non-marginal tarsal border"

"globe pushed straight out; cavernous hemangiomas, AV fistulas, meningioma, glioma, muscle cone tumor"

"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 "

incisional biopsy

papillary palpebral conjunctiitis

"occurs intraepidermally, whereby cells proliferate singly or in nests at all levels of epidermis"

excision with sentinel lymph node biopsy

tumor cells appear vacuolated due to the fat/lipid that is removed by alcohol during processing

posterior medial

voluntary eyelid closure (squeezing); unconscious blinking; innervated by CN VII

"obicularis, procerus, corrugator superciliaris"

junctional; intradermal

if digital compression fails to resolve it in 1-2 weeks

lower lid blepharoplasty associated with retrobulbar hemorrahge

cDCR (conjunctivodacryocystorhinostomy)

angular artery

choroidal artery occulsions you get no perfusion of short posterior ciliary arteries so you get no choroidal flush

"facial artery, which comes from external carotid artery circulation (not ophthlamic artery, which branches from internal carotid)"

fresh tissue without preservatives to get flow cytometry and cell surface markers

"30%; 90% have high thyroid, 6% euthyroid, 3% have hashimotos 1% have primary hypothyroidism"

"holocrine, exocrine, apocrine (Molly is a sweaty Ape), exocrine"

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

inferior fornix (jerry KRAUSE is a lowlife hiding in the bottom)

lymphangioma; spontaneous hemorrhage intralesionally (lymphatic component can be deduced by history of enlarging with URIs)

"levator, Inf oblique, sup oblique"

"skin and subcutaneous tissue, temporoparietal fascia (SMAS), loose areolar tissue, deep temporal fascia, temporalis muscle"

"nevus is from undifferentiated melanocytes found at the epidermal/dermal border, freckle is from melanocytes producing too much pigment"

"sphenoid wing meningioma, optic nerve sheath meningioma (most likely), low grade optic glioma, chronic papilledema, chronic glaucoma, old CRVO"

"like varices and hemorrhoids, anything that prevents chronic poor drainage of the central retinal vein"

myogenic; poor development of levator muscle

non-marginal tarsal border

"lacrimal gland, glands of wolfring and krause"

angular artery and vein

"deepening of the lower fornix, ptosis of the lower lid, white subconjunctival line below the tarsus, little movement of the lower eyelid with downgaze"

"TSH (10% have thymomas, and removing thymoma can improve function)"

eyelid

"maxillary branch of CN V, inferior ophthalmic vein"

upper eyelid ; sebaceous cell is cancer of meibomian glands and zeis glands which are more common in upper lid

25-50%

"when lesions aproach the chiasm (surgery), when lesions invade the chiasm (surgery/chemo)"

juvenile pilocytic (hairlike) astrocytoma

ethymoid and maxillary

changes direction of levators force from anterior posterior to superior inferior

levator

"obstructing visual axis, induces refractive error"

"slow growing lesion, no ecchymosis typical for capillary hemangioma"

EIC has central pore and filled with keratin while hidrocystoma is smooth and filled with fluid

"clear tearing is caused by obstruction of upper system: puncta, canaliculus, common canaliculus while mucopurulent discharge is caused by NLDO"

prevents release of acetylcholine into neuromuscular junction

enlargment of lacrimal sac above medial canthus tendon and bloody discharge; squamous cell papillomas and carcinomas

normal CBC and muscle tendon inflammation

"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"

25-40; 20-30

carotid cavernous fistua

6 weeks; lacrimal gland become fully formed and functions at 6 weeks

20 days after birth (contradiction with 6 weeks when lacrimal gland formed?)

5mm cuts/3mm cuts

if you suspect it involves mainly skin and obicularis (tarsus appears normal)

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

releaving the ostial occlusion and reconstructino of orbital floor

compression of the posterior ciliary arteries (more compressible than central retinal artery)

lateral canthus (most common is lesions of lower eyelid > medial canthus > upper eyelid > lateral canthus= mneumo: IMSL im slow)

25 mm/ 18 mm

"mneumo: SMEL (sphenoid lesser wing, maxillary, ethymoid, lacrimal)"

front less- frontal bone and lesser wing of sphenoid

"maxillary, zygomatic, palatine"

zygomatic and greater wing of sphenoid

"upper lid 10-12mm, lower lid 4mm"

7x

floor

capillary hemangioma

"skin, obicularis, septum, orbital fat, levator, muller's muscle conjunctiva"

lateral retraction worse than medial retraction (lateral flare)

"caruncle, middle meatus"

anterior tendon resopnsbiel for structural support of eyelid; posterior tendon responsible for keeping the eyelid and punctum apposed to the globe

suspicion of obstruction at valve of Hasner (valve between nasolacrimal duc and inferior meatus) in children

neuroblastoma

periosteum

orbital roof

low flow dural cavernous fistula

spastic entropion

"horizaontal lengthening of the eyelid, eyelid retractor disinsertion, over-riding obicularis"

shortened anterior lamellae causing traction on the lower eyelid

peripheral anterial arcade

"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"

"Standing Room Only (V1 goes through superior orbital fissure, V2 foramen rotundum V3 foramen ovale"

inferior oblique sepearates medial and central fat pads

90%; 70%

lesser wing of sphenoid

arachnoid villi

sudden onset of multilpe seborrheic keratoses; asosciated with GI adenocarcinoma

squamous cell carcinoma

"chronic dacryocystitis, epiphora"

bloody tears and regional lymphadenopathy

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

"hydroxyapatite, has tiny pores so soft tissue can grow in"

10%

"10mm, 15-18mm"

squamous cell carcinoma (usually arising in maxillary sinus)

12-15mm; 12mm

posterior to anterior portion of medial canthal tendon

myogenic; poor development of levator muscle