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Disease Processes > Cosmetic > Flashcards

Cosmetic Flashcards

1
Q

Normally, how many hair follicles are contained within 1cm3 of scalp?

A

200

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2
Q

What percent of patients with secondary hyperparathyroidism require parathyroidectomy?

A
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3
Q

What are the primary theories on the etiology of infraorbital bags?

A
    1. Congenitally excess fat.
    1. Weakening of the orbital septum and attenuation of the orbicularis oculi.
  • 3• Weakening of global support resulting in enophthalmos and lower lid pseudoherniation.
  • 4•Weakening and descent of the Lockwood suspensory ligament.
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4
Q

What are the indications for parathyroid exploration in patients with asymptomatic or minimally symptomatic hyperparathyroidism?

A
  • Age less than 50
  • History of a life-threatening hypercalcemic episode.
  • Kidney stones on abdominal X-rays.
  • Serum calcium 1mg/mL above the upper limits of normal for the lab.
  • Creatinine clearance reduced by 30% or more compared with age-matched normal persons.
  • 24-hour urinary calcium excretion >400 mg.
  • T-score at lumbar spine, hip, or distal radius less than -2.5. Poor follow-up expected.
  • Coexistent illness complicating conservative management.
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5
Q

What percent of cases of primary hyperparathyroidism are due to diffuse hyperplasia?

A

14-16%.

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6
Q

What percent of cases of primary hyperparathyroidism are due to carcinoma?

A

3%.

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7
Q

Approximately what percent of hair follicles must be lost before hair loss is noticeable?

A

30%.

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8
Q

What is the pathophysiology of androgenetic alopecia?

A

Affected scalp follicles inhibit androgen, causing terminal hairs to convert to vellus hairs.

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9
Q

What is another cause of bone disease in patients with renal failure that should be ruled out prior to parathyroidectomy?

A

Aluminum bone disease.

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10
Q

What is the most common cause of hair loss in men and women?

A

Androgenetic alopecia or male pattern baldness.

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11
Q

What is the primary cause of jowls in the elderly patient?

A

Attenuation of the masseteric cutaneous ligaments.

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12
Q

What are the indications for parathyroidectomy in patients with secondary hyperparathyroidism?

A

Bone pain (most common indication), intractable pruritus, calcium-phosphate product over 70 despite medical treatment, calciphylaxis, and osteitis fibrosa cystica.

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13
Q

Which cell is most commonly proliferated in diffuse parathyroid hyperplasia?

A

Chief cell.

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14
Q

What is the pathophysiology behind secondary hyperparathyroidism from chronic renal failure?

A

Chronic hypocalcemia results from decreased production of 1,25(0H) 2 vitamin D3, bone resistance to PTH, and decreased clearance of PTH and phosphate, resulting in parathyroid hyperplasia and increased levels of PTH.

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15
Q

What is the most common cause of secondary hyperparathyroidism?

A

Chronic renal failure.

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16
Q

What are the indications for calcium supplementation after thyroid or parathyroid surgery?

A

Circumoral paresthesias, anxiety, positive Chvostek’s or Trousseau’s sign, tetany, ECG changes, or serum calcium less than 7.1 mL/dL.

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17
Q

What is the significance of elevated preoperative levels of alkaline phosphatase in patients with chronic renal failure undergoing parathyroidectomy?

A

Correlates with a good chance of amelioration of bone pain after parathyroidectomy.

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18
Q

What are the CNS manifestations of myxedema?

A

Depression, memory loss, ataxia, frank psychosis, myxedema, and coma.

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19
Q

What is the medical management of secondary hyperparathyroidism?

A

Dietary phosphate restriction, phosphate binders, calcium and vitamin D supplementation (calcitriol), sodium bicarbonate (for metabolic acidosis), charcoal hemoperfusion (for pruritus), bisphosphonates.

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20
Q

What is the anatomic basis of “hanging columella”?

A

Excessively high arch of the alae, abnormally extreme curvature of the intermediate and medial crura, or overaggressive surgical removal of the lateral crus and adjacent soft tissue with subsequent cephalic contraction of alar margin.

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21
Q

What is the most common presentation of severe hypercalcemia?

A

Extreme lethargy.

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22
Q

What disease should be ruled out on all patients with hypercalcemia?

A

Familial benign hypocalciuric hypercalcemia (FHH).

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23
Q

What clinical sign is the hallmark of thyroid storm?

A

Fever.

24
Q

What causes melasma?

A

Genetic predisposition, exposure to UV radiation, pregnancy, oral contraceptives, thyroid dysfunction, cosmetics, phototoxic and antiseizure drugs.

25
Q

What are the most common causes of hyperthyroidism?

A

Graves’ disease, toxic multinodular goiter, relapsing thyroiditis, amiodarone-induced thyrotoxicosis, autonomous toxic nodule, subacute thyroiditis, and pituitary tumor.

26
Q

What are the most common causes of hypothyroidism?

A

Hashimoto’s thyroiditis, pituitary tumor, thyroidectomy, and radioactive J131 treatment for thyrotoxicosis.

27
Q

A 45-year-old woman presents with a 2-year history of diffuse, tender thyroid enlargement, lethargy, and a 20-pound weight gain. What is the most likely diagnosis?

A

Hashimoto’s thyroiditis.

28
Q

What is the major cause of a decreased T3 concentration in patients with a critical illness?

A

Impaired peripheral conversion of T4 to T3 secondary to inhibition of the deiodination process.

29
Q

What is the immediate treatment for patients with acute symptomatic hypocalcemia?

A

Intravenous calcium gluconate.

30
Q

What is the initial treatment of thyroid storm?

A

Intravenous fluids, hypothermia, acetaminophen, propranolol, propylthiouracil, and iodine.

31
Q

What is the first-line therapy for patients with marked hypercalcemia and/or severe symptoms?

A

Intravenous hydration followed by furosemide.

32
Q

What is the most common form of acquired eyelid ptosis?

A

Levator aponeurosis disinsertion or dehiscence.

33
Q

What is the most common thyroid abnormality in hospitalized patients with nonthyroidal illness?

A

Low T3 concentration.

34
Q

What is Binder’s syndrome?

A

Maxillonasal dysplasia with inadequate projection, absent nasal spine, premaxillary hypoplasia, severe columellar-lobular disproportion.

35
Q

Which type of multiple endocrine neoplasia is not associated with hyperparathyroidism?

A

MEN IIb.

36
Q

What is the classic bony change associated with hypercalcemia?

A

Osteitis fibrosa cystica; manifested as subperiosteal bone resorption in the phalanges, pelvis, distal clavicles, ribs, femur, mandible, or skull.

37
Q

What is the most common cause of primary hyperparathyroidism?

A

Parathyroid adenoma.

38
Q

What is tertiary hyperparathyroidism?

A

Parathyroid hyperplasia results in autonomous hypersecretion such that hyperparathyroidism continues despite correction of the underlying renal disease.

39
Q

A 48-year-old man has a serum calcium of 13 mg/dL and a serum PTH of 400 mEqjmL. What is the most likely diagnosis?

A

Primary hyperparathyroidism secondary to a parathyroid adenoma.

40
Q

What is the most common cause of hypercalcemia?

A

Primary hyperparathyroidism.

41
Q

A 25-year-old pregnant woman, in her 2nd trimester, presents with hyperparathyroidism and a serum calcium of 12 mg/dL. What is the treatment of choice?

A

Prompt parathyroid exploration.

42
Q

What is the primary cause of midface aging?

A

Ptosis of the malar fat pads and diminished tone of the zygomatic musculature.

43
Q

What is the treatment of choice for patients with parathyroid carcinoma?

A

Radical resection of the involved gland, the ipsilateral thyroid lobe, and the regional lymph nodes.

44
Q

A 35-year-old woman has a serum calcium of 8.5 mg/dL, a serum PTH of 400 mEqjmL, and a serum creatinine of 5.6 mg/dL. What is the most likely diagnosis?

A

Secondary hyperparathyroidism.

45
Q

What is calciphylaxis?

A

Severe soft tissue calcification that can result in deep nonhealing ulcers and gangrene.

46
Q

What are the causes of lower lip eversion?

A

Skeletal deep bite, lower tooth procumberance, excess lip weight and bulk.

47
Q

What is the treatment of choice for patients with hyperparathyroidism associated with MEN-I or MEN-IIa?

A

Subtotal (3112 gland) parathyroidectomy or total parathyroidectomy with autotransplantation.

48
Q

What are the hemodynamics of thyroid storm?

A

Tachycardia, increased cardiac output, and decreased systemic vascular resistance.

49
Q

What landmark is used to determine the correct position of the natural hairline?

A

The apex of the frontotemporal triangle should fall on a vertical line intersecting the lateral canthus.

50
Q

What are the histologic features of photoaged skin?

A

Thickened stratum corneum, thinner atrophic epidermis with atypia, irregular dispersion of melanin, decreased glycosaminoglycans, and abnormal elastic fibers in the dermis (solar elastosis).

51
Q

What are the clinical features of photoaged skin?

A

Thicker than normal with wrinkling, roughness, sallowness, telangiectasias, mottled hyperpigmentation, and loss of elasticity.

52
Q

Which hair follicles are most likely to be involved in androgenetic alopecia?

A

Those in the frontotemporal and crown regions of the scalp.

53
Q

What is the appropriate treatment for the above patient?

A

Thyroid hormone replacement therapy.

54
Q

True/False: Complete avoidance of sunlight can reverse some of the histologic signs of photoaging.

A

True.

55
Q

What is the most common cause of thyroid storm?

A

Untreated Graves’ disease.

Disease Processes (9 decks)

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