Ocular Disease - Midterm 1 Lids Part 1

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Ocular Disease - Midterm 1 Lids Part 1 - Quiz

Questions and Answers
  • 1. 

    Basal cell carcinomas (BCC) metastasize quickly and is a fast growing lesion. Patients will often report the growth came out of nowhere and they just noticed it 

    • A.

      True

    • B.

      False

    Correct Answer
    B. False
    Explanation
    Metastasis is unlikely if it does it will go to the regional lymph node. Therefore you need to palpate preauricular and sudmandiublar nodes for swelling and tenderness.
    Patients will most likely report that it has been there for a long time, it doesnt' go away and does not heal

    It spreads by direct metastasis

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  • 2. 

    Port wine stains are often associated with what syndrome?

    • A.

      Horner's syndrome

    • B.

      Sturge-Weber syndrome

    • C.

      Moh's syndrome

    • D.

      Noon's syndrome

    Correct Answer
    B. Sturge-Weber syndrome
    Explanation
    pg. 34

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  • 3. 

    What danger does a basal cell carcinoma (BCC) that is located in the medial canthal region present to the patient?

    • A.

      It has a high chance of metastasis

    • B.

      Surgery by Moh's technique is less likely to be successful, thus treatment will be limited to cryo and conventional surgery

    • C.

      It is more likely to directly extend intracranially without apparent nature when grossly observing the lesion

    • D.

      It is less dangerous in this region because it is further from the regional lymph node

    Correct Answer
    C. It is more likely to directly extend intracranially without apparent nature when grossly observing the lesion
    Explanation
    pg. 38

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  • 4. 

    Squamous cell carcinoma (SCC) can often arise from what pre-existing conditions?

    • A.

      Capillary hemangioma

    • B.

      Existing actinic keratosis or a cutaneous horn

    • C.

      Nevus of Ota

    • D.

      Hutchison's freckle

    • E.

      Port wine stain

    Correct Answer
    B. Existing actinic keratosis or a cutaneous horn
    Explanation
    Hutchison's freckle - precursor to malignant melanoma
    Nevus of ota - can develop into a malignant melanoma

    Developmental vascular lesions - Capillary hemangioma and port-wine stain

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  • 5. 

    The classic appearance of squamous cell carcinoma (SCC) is a center which slowly ulcerates with an increase in size. It tends to have darkened, ulcerated center. 

    • A.

      True

    • B.

      False

    Correct Answer
    B. False
    Explanation
    The description is for a BCC - pg. 37
    4 types of BCC: nodular (common); superficial (back and trunk); sclerosing waxy yellow "scar tissue"; indistinct borders, multicentric type

    SCC does NOT have a classical appearance: it can be raised nodule; flat crusty area; flat scaly area; ulcerated bleding lesion, thickened margins - pg. 39

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  • 6. 

    Absence of superior lid sulcus in Caucasian people will lead you to believe the person could have a congenital ptosis, especially if the person is young. 

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    Explanation
    The absence of a superior lid sulcus in Caucasian people can indicate a congenital ptosis, particularly in younger individuals. This suggests that the person may have been born with a drooping upper eyelid, which could be a result of a developmental issue. Therefore, it is true that the absence of a superior lid sulcus in Caucasian people could lead one to suspect a congenital ptosis.

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  • 7. 

    A concerned mother bring in her 6 yo daughter. She reports the child is having trouble at school. While walking to the exam room you notice the child's OD eye shows heterochromia irides and a slight ptosis. Although you still need to do a full exam, take a case history and ask to look at old family photos, what condition is at the top of your differential diagnosis list? 

    • A.

      Marcus Gunn jaw winking syndrome

    • B.

      Neonatal myasthenia gravis

    • C.

      Congential Horner's syndrome

    • D.

      Duane's retraction syndrome

    Correct Answer
    C. Congential Horner's syndrome
    Explanation
    If significant obstruction of pupil and/or apparent reduced acuity or dislike for fixation with the eye then consult with pediatric ophthalmologist is strongly advised. Ptosis must be eliminated to prevent occlusion amblyopia

    Pediatric neurology (or ophthalmology) consult if congenital Horner’s or suggestion of neonatal myasthenia gravis

    Duane's retraction syndrome - pg. 7
    Marcus Gunn jaw winking syndrome - pg 11
    Congential Horner's syndrome - pg. 11

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  • 8. 

    You have a 57yo Caucasian male who comes into to your office after an OMD gave them a referral for VT. during slit lamp evaluation who notice there appears to be an adhesion b/t the upper and lower eyelids on the temporal aspect of their eye. You have the patient look to the right and to the left and tug on the eye a little bit, You can envision where the eyelid probably once was. Since this is only present on one eye it gives the patient the appearance of a strabismus.  You decide to place the patient on immunosuppressive medication, b/c this acquired anomaly is normally due to autoimmune condition, in this case you chose cyclosporine. The patient  is very adamant about getting this repaired so you make a referral to a oculoplastic surgeon. On the referral what diagnosis would you provide?

    • A.

      Euryblepharon

    • B.

      Ankyloblepharon

    • C.

      Vitiligo

    • D.

      Cicatricial entropion

    • E.

      Atonic entropion

    Correct Answer
    B. Ankyloblepharon
    Explanation
    pg. 12 -13

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  • 9. 

    What danger could accompany entropion?

    • A.

      Distichiasis

    • B.

      Epiphora

    • C.

      Poliosis

    • D.

      Trichiasis

    • E.

      Blepharospasm

    Correct Answer
    D. Trichiasis
    Explanation
    Distichiasis - congential anomaly characterized by absence if meibomian glands which have an extra row of lashes at their location - pg. 10

    Poliosis - normally seen in vitiligo - pg. 12

    Blepharospasm - pg. 18

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  • 10. 

    A 67 yo Caucasian male has come into your office with a chief complaint of irritation and pain in their eye. During the patient's case history you find out they have recently immigrated from South Africa.  On slit lamp evaluation you notice a scar on the tarsal conjunctiva. You suspect the patient has an inflammation of the tarsal conjunctiva such as a trachoma. What diagnosis would you type into EMR. 

    • A.

      Cicatricial entropion

    • B.

      Dermatochalaisis

    • C.

      Spastic entropion

    • D.

      Blepharochalaisis

    Correct Answer
    A. Cicatricial entropion
    Explanation
    pg. 13

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  • 11. 

    Staphylococcal exotoxins may cause hypersensitivity reactions. Select the two conditions that apply and are allergic responses of conjunctiva and cornea to chronic exotoxin release. 

    • A.

      Phlyctenules

    • B.

      Keratitis

    • C.

      Marginal corneal infiltrates

    • D.

      Tylosis

    • E.

      Hyperemic conjunctiva adjacent to corneal involvement

    Correct Answer(s)
    A. Phlyctenules
    C. Marginal corneal infiltrates
    E. Hyperemic conjunctiva adjacent to corneal involvement
    Explanation
    Hypersentivity reactions associated with staphylococcal blepharitis, occurs over days and weeks, rather than hours.

    Keratitis is due to pooling of exotoxins in tear lake, also due to lipases breaking lipis into surface active free fatty acids and from poor blinking

    Tylosis - thickening of eyelashes, permanent strucutural changes, changes due to exotoxins damaging tissue.
    pg. 56

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  • 12. 

    Which of the following is not considered a lid characteristic in staphylococcal blepharitis.  

    • A.

      Erythema

    • B.

      Elevated WBC count

    • C.

      Puffy from fluid accumulation

    • D.

      Tender to palpation

    • E.

      Acute changes due to hypersensitivity

    Correct Answer
    B. Elevated WBC count
    Explanation
    pg. 56

    Mnemonic: PETA = Puffy, erythema, tender, acute changes

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  • 13. 

    A 6yo male is brought in by his mother for an eye exam during summer vacation.  During the exam you notice the child has lesions, they are larger bistered areas with superficial crust. Since you are doing your residency at the Indian Health services clinic you decide to take care of the lesions and help improve the child's appearance. You soak the lesions with Burow's solutions for 20 minutes to soften the crust and for its astringent action then you gently debride the crust with a washcloth. You would prefer to use the newest drug therapy Mupirocin (Bactroban) 2% ointment because its effective against both Staph and group A Strep. However since you are at Indian health services all you can do is use chlorhexidene solution to further cleanse the area after which you dry the lesions and apply Polysporin without a covering bandage. 

    • A.

      Actinic keratosis

    • B.

      Bullous Impetigo

    • C.

      Benign melanotic lesions

    • D.

      Keratoacanthoma

    Correct Answer
    B. Bullous Impetigo
    Explanation
    pg. 53

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  • 14. 

    Which of the following is not a differential diagnosis for blepharospasm. 

    • A.

      Functional (hysterical)

    • B.

      Myokymia

    • C.

      Tardive dyskinesia caused by antipsychotic medications (Prolixin, Haldol)

    • D.

      Blepharoclonus

    • E.

      Ocular disease (local irritation, inflammatory process, or foreign body)

    Correct Answer
    D. Blepharoclonus
    Explanation
    pg. 19

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  • 15. 

    Which statement is false regarding Myokymia?

    • A.

      Causes include anemia, anterior segment irritation, excessive use of alcohol or tobacco

    • B.

      Medications interfering with nerve conduction are variably, but not consistently successful. Recently people have been reporting success with therapy coupled with Botulin A toxin injections, the symptoms will subside for an average of 3 months.

    • C.

      Suggest oral quinine 200-300mg qd to tid for stubborn cases, but contraindicated in pregnant women since increases risk of abortion.

    • D.

      Dirty water orally bid to tid is another suggestion for the treatment of myokymia

    Correct Answer
    B. Medications interfering with nerve conduction are variably, but not consistently successful. Recently people have been reporting success with therapy coupled with Botulin A toxin injections, the symptoms will subside for an average of 3 months.
    Explanation
    Option 2 - Tx option for blepharospasm

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  • 16. 

    Select the false statement

    • A.

      Ankyloblepharon causes pseudostrabismus and is often the result from significant mucocutaneous disease such as ocular pemphigoid or as a congential anomaly

    • B.

      Spastic entropion occurs in elderly due to age-related lid changes

    • C.

      Vitiligo is usually accompanied by poliosis and alopecia

    • D.

      Symblepharon typically occurs as the tarsal conjunctiva and bulbar conjuntiva heal it results generally from significant inflammatory disease, Stevens-Johnson syndrome, pemphigoid, alkali burn

    Correct Answer
    B. Spastic entropion occurs in elderly due to age-related lid changes
    Explanation
    Option 2 - Most common cause is blepharospasm due to ocular irritation, injury, inflammation(conjunctivitis, keratitis,etc.). Caused by excessive contraction of palpebral portion of orbicularis (or very rarely atrophy of the lid retractors)

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  • 17. 

    Select the false statement

    • A.

      When evaluating entropion having the patient open their mouth will help differentiate between cicatricial and involutional entropic. Cicatricial entropion will get worse when the patient opens their mouth.

    • B.

      Cicatricial entropion is usually caused by inflamation of tarsal conjunctiva from infection such as trachoma

    • C.

      Atonic entropion can occur due to elongation of lid stuctures laxity of tarsal plate and orbital septum, orbicularis spasm, atrophy of orbital fat with age, and also lower lid retractors

    • D.

      Management for congential entropion is surgical reformation of tarsal plate

    • E.

      Trichiasis can cause corneal epithelial defects such as corneal infections, ulcers, damage and scarring in anterior stroma

    Correct Answer
    A. When evaluating entropion having the patient open their mouth will help differentiate between cicatricial and involutional entropic. Cicatricial entropion will get worse when the patient opens their mouth.
    Explanation
    pg 13-14

    Option 1 - refers to ectropion

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  • 18. 

    Select the appropriate treatments for the management of ectropion since the goal will be to prevent discomfort, tearing, secondarykeratinization and or infection. 

    • A.

      Extended wear contact lens to protect cornea

    • B.

      Steroids to decrease infection

    • C.

      Surgical treatment

    • D.

      Broad spectrum antibiotic if recurrent infections auch as blepharitis, conjunctivitis or keratitis

    Correct Answer(s)
    A. Extended wear contact lens to protect cornea
    C. Surgical treatment
    D. Broad spectrum antibiotic if recurrent infections auch as blepharitis, conjunctivitis or keratitis
    Explanation
    pg.16

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  • 19. 

    Preseptal Cellulitis

    • A.

      Orbital cellulitis can worsen into preseptal cellulitis

    • B.

      Causes include dental surgery, ethmoidal wall fracture or other trauma

    • C.

      Common organisms involved include H.influenzae in children and Strep and Staph in adults

    • D.

      Signs include diplopia, pain on eye movement, external ophthalmoplegia, optic nerve edema and ischemia with variable/mild VA loss

    • E.

      The drug of choice for treatment is a topical antibiotic steroid combo

    Correct Answer
    C. Common organisms involved include H.influenzae in children and Strep and Staph in adults
    Explanation
    pg.50-52

    Option 2 and 4 are in reference to orbital cellulitis

    Antibiotic/steroid ointment - TMZ is not PG Blep: TobradexST, Maxitrol, Zylet, Pred-G, Blephamide - Tx for staphlococcal blepharitis

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  • 20. 

    Early diagnostic sign of preseptal cellulitis is conjunctival hyperemia and chemosis (moderate to severe); these frequently precede proptosis and diplopia

    • A.

      True

    • B.

      False

    Correct Answer
    B. False
    Explanation
    For orbital cellulitis
    pg.51

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  • 21. 

    Which of the following is not an oral antibiotic that can be used for the treatment of preseptal cellulitis?

    • A.

      Erythromycin

    • B.

      Bactrim

    • C.

      Maxitrol

    • D.

      Augmentin

    Correct Answer
    C. Maxitrol
    Explanation
    pg.52
    Maxitrol -Topical Antibiotic Steroid Combo

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  • 22. 

    Augmentin (aka amoxicillin/clavulanic acid) at a dosage of 250-500 TID can be used to treat staphylococci, streptococci and H.flu

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    Explanation
    pg 52-53

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  • 23. 

    Seborrheic Blepharitis

    • A.

      Can also be referred to as posterior blepharitis, when this occurs there can be a significant build-up of fatty esters

    • B.

      There is frequent occurrence with dermatologic conditions such as Rosacea

    • C.

      Signs include frothing of tear film at outer canthi, papillary conjunctivitis, bulbar conjunctival hyperemia, retention cysts and concretions

    • D.

      First line therapy is lid hygiene and Azasite or TobradexST

    • E.

      Inflammation exists concurrently with stagnation spotty, scattered involvement of abnormal glands

    Correct Answer
    B. There is frequent occurrence with dermatologic conditions such as Rosacea
    Explanation
    The other options are in refers to meibomitis

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  • 24. 

    What is the third line treatment for meibomian gland dysfunction? What medication do you need to use? 

    • A.

      Azasite or TobradexST 1 gtt BID for 2days, then 1 gtt qHS for 1 month

    • B.

      Cyclosporine/Restasis 1 gtt BID

    • C.

      Doxycycline 50mg BID x 2 weeks, then taper to 20mg qDaily

    • D.

      Tetracycline 250mg QID x 2 weeks. Slow taper to maintenance dose of 250mg per day or every other day

    Correct Answer
    B. Cyclosporine/Restasis 1 gtt BID
    Explanation
    pg. 68

    Additional new treatment modalities: Intraductal meibomian gland probing; LipiFlow thermal pulsation system
    Life long condition

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  • 25. 

    Primary meibomitis is the least serious/least threatening stage of meibomitis   

    • A.

      True

    • B.

      False

    Correct Answer
    B. False
    Explanation
    pg. 67
    Most severe variety of meibomian gland dysfunction. Strong association w/dermatological conditions such as rosacea. Frequent chalazia

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  • 26. 

    Changes in the lid margin are primarily due to either staphylococcal and/or meibomian gland disorders, not to simple seborrheic processes

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    Explanation
    pg. 62

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  • 27. 

    Which statements are true regarding seborrheic blepharitis

    • A.

      Lid margin hyperemia can be due to neovascularization from chronic staphylococci, markedly inflamed meibomian glands, ocular rosacea

    • B.

      It is best treated by using alternating ointments (bactracin and erythromycin) the first five nights qHS of each month

    • C.

      Scurf are also referred to as dandruff-like scales, they can be confused with fibrinous scales in appearance

    • D.

      It is very responsive to steroids

    Correct Answer(s)
    A. Lid margin hyperemia can be due to neovascularization from chronic staphylococci, markedly inflamed meibomian glands, ocular rosacea
    C. Scurf are also referred to as dandruff-like scales, they can be confused with fibrinous scales in appearance
    Explanation
    Option 2 and Option 4 - pg. 58 & 60

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  • 28. 

    Select the true statement regarding antibiotic ointments for staphylococcal blepharitis

    • A.

      Sulfacetamide is the drug of choice in the treatment of staphylococcal blepharitis. However there is a risk of sunburned eyelids with increased photosensitivity

    • B.

      Erythromycin causes extreme hypersensitivity reactions and high toxicity to tissue

    • C.

      Tobramycin is very good against staphylococci and must primarily reserve it for keratitis, due to its effectiveness against Pseudomonas aeruginosa

    • D.

      There is no risk of delayed hypersensitivity reaction and very little resistance of staphylococci to Neomycin

    • E.

      Gentamicin is a very poor choice against staphylococci at present so it should never be used long term

    • F.

      Bacitracin is has high toxicity, it is available only in oral form, there is extreme resistance and hypersensitivity.

    Correct Answer
    C. Tobramycin is very good against staphylococci and must primarily reserve it for keratitis, due to its effectiveness against Pseudomonas aeruginosa
    Explanation
    pg 59-60

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  • 29. 

    Select the false statement regarding oral antibiotics for staphylococcal blepharitis

    • A.

      They are the first line of treatment for blepharitis

    • B.

      Doses of oral antibiotics depend on patient's age, weight, and severity of condition

    • C.

      If considering using oral antibiotics, consider culture and sensitivity testing (best oral or topical to use) and choose least irritating oral antibiotic

    • D.

      Tetracycline is contraindicated for pregnant and lactating females as well as children under 12

    Correct Answer
    A. They are the first line of treatment for blepharitis
    Explanation
    pg.60

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  • 30. 

    Erythromycin can often clear an unresolved hordeolum which remained inflamed while progressing into a chalazion or a chalazion which has become reinfected. Dosage would be 1-2gm/day. 3-4 weeks. 

    • A.

      True

    • B.

      False

    Correct Answer
    B. False
    Explanation
    Ans: Tetracycline does the above.
    pg. 49

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  • 31. 

    Which of the following topical antibiotic ointments is not suggested for pediatric use?

    • A.

      Ciloxan/ciprofloxacin 0.3%

    • B.

      Ilotycin/erythromycin 0.5%

    • C.

      Tobrex/tobramycin 0.3%

    • D.

      Neosporin/polymyxin B/neomycin/gramicidin

    Correct Answer
    D. Neosporin/polymyxin B/neomycin/gramicidin
    Explanation
    pg. 14

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  • 32. 

    Which of the the following topical antibiotic drops is/are allowed to be used for pediatrics  in ages >8yo?

    • A.

      Ciloxan/ciprofloxacin 0.3%

    • B.

      Azasite/azithromycin 1%

    • C.

      Zymar/gatifloxacin 0.3%

    • D.

      Vigamox/moxifloxacin 0.5%

    Correct Answer
    B. Azasite/azithromycin 1%
    Explanation
    pg. 15
    JUST REMEMBER ONLY THE TETRACYCLINE DROP CAN BE USED ON PEDS, all the other drops are of the fluoroquinolone and aminoglycoside drug class

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  • 33. 

    Select the false statement regarding the management of trichiasis

    • A.

      When epilating the lashes it is important not to clip the lashes but to grasp firmly at its base and pluck

    • B.

      Cauterization of follicles is a highly valued and useful treatment

    • C.

      Electrolysis destroys lash follicles, however the procedure is quiet painful

    • D.

      If > 1/3 of lashes are turned in, surgery is warranted rather than electrolysis: cryosurgery and argon laser photocoagulation

    Correct Answer
    B. Cauterization of follicles is a highly valued and useful treatment
    Explanation
    pg. 22

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  • 34. 

    Blepharitis is the most common cause of trichiasis 

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    Explanation
    pg. 21

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  • 35. 

    Which statement is false?

    • A.

      The most common cause of madarosis is staph blepharitis

    • B.

      Management of an ingrown cilia requires prophylaxis with a topical antibiotic ointment

    • C.

      Dermatochalasis may have a herniation of orbital fat through the orbital septum causing puffy, "swollen" appearance.

    • D.

      A verruca is generally a non-viral version of a papilloma

    • E.

      Blepharochalaisis is the recurrences of edema that result in streching of periorbital skin, loss of elasticity.

    Correct Answer
    D. A verruca is generally a non-viral version of a papilloma
    Explanation
    A verruca is generally a non-viral version of a papilloma. This statement is false because a verruca is actually a viral infection caused by the human papillomavirus (HPV). A papilloma, on the other hand, can refer to any benign tumor that grows on the surface of the skin or mucous membranes, and it can be caused by various factors, including viral infections. Therefore, a verruca is a type of papilloma that is specifically caused by HPV.

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  • 36. 

    Which statements are true in the management of papillomas?

    • A.

      Generally no treatment is indicated and the patient just need to be reassured

    • B.

      Lance it with a 18-27 gauge needle then cover with broad spectrum antibiotic

    • C.

      Excision techniques include the scissors/scalpel technique and the chemical technique in which bichloroacetic acid is applied to the lesion and allowed to fall off

    • D.

      If the lesion is new it must be evaluated for evidence of malignant characteristics; photograph and follow up in one to three months.

    Correct Answer(s)
    A. Generally no treatment is indicated and the patient just need to be reassured
    C. Excision techniques include the scissors/scalpel technique and the chemical technique in which bichloroacetic acid is applied to the lesion and allowed to fall off
    D. If the lesion is new it must be evaluated for evidence of malignant characteristics; photograph and follow up in one to three months.
    Explanation
    Option 2 - excision technique for sudoriferous cysts

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  • 37. 

    Keratoacanthoma spontaneously regresses by involution but very often mistaken for squamous cell. Because of this appearance, usually excised during phase of involutional regression. If there is a recurrence after excision is was almost definitely BCC or SCC, not keratoacanthoma. 

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    Explanation
    pg. 29-30

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  • 38. 

    Sebaceous gland cysts

    • A.

      Are elevated rounded lesions caused by blockage of the gland of Moll

    • B.

      Can be divided into three types: Dermal, compound, and junctional

    • C.

      Have their cystic nature apparent in indirect/proximal illumination

    • D.

      Can manifest as subcutaneous or superficial in depth

    Correct Answer
    D. Can manifest as subcutaneous or superficial in depth
    Explanation
    Option 1 - refers to sudoriferous cysts
    Option 2 - refers to nevi
    Option 3 - refers to sudoriferous cysts

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  • 39. 

    Developmental vascular lesions 

    • A.

      Can change in color with venous return; activities such as straining, crying, lifting can cause redder appearance

    • B.

      Are usually found in areas of chronic sun exposure, they are slow growing and often take months to double in size

    • C.

      Usually spontaneously regress completely by age 5

    • D.

      Will often present with signs of acute inflammation such as redness, heat, pain, swelling etc.

    • E.

      Produce flat reddish or pink lobulated lesion on skin

    Correct Answer(s)
    A. Can change in color with venous return; activities such as straining, crying, lifting can cause redder appearance
    C. Usually spontaneously regress completely by age 5
    E. Produce flat reddish or pink lobulated lesion on skin
    Explanation
    pg. 34

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  • 40. 

    What oral antibiotic did Dr. Tong say was to be prescribed for individuals with a hordeolum and a sensitive stomach?

    • A.

      Oracea 40mg BID

    • B.

      Achromycin 250-500 QID

    • C.

      Erythromycin EES 400mg QID

    • D.

      Doryx 50,100,200mg BID

    Correct Answer
    C. Erythromycin EES 400mg QID
    Explanation
    pg. 45

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