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Case 1: Acute glaucoma presenting with eye pain and papilledema

Clinical vignette:

This 40 year old male presented to the emergency room with loss of vision and severe pain in his left eye. Several months ago he had been told that his irides were unusually far forward but his vision was normal and so this statement didn't impress him at the time. On examination, the pupil was large and the cornea was clouded with a pebbly surface. His sclera was blood shot and there was a prominent capillary blush around the limbus of the effected eye.

1. What is the most likely diagnosis? Be specific as to what type? What is the prognosis for his vision? How long do you have to look this up while your patient sits in the waiting room?
2. If you could see through the cornea what would the optic disk look like and why?
3. How are you going to treat this patient? (Yes, you have had this in pharmacology.)
4. What might have been done for this patient back when he was first told that something was wrong with his irides?

Case 2: Blurring and Distortion

Clinical vignette:

This 60 year old white male became aware of blurring and distortion of part of the visual field of one eye while being tested for new glasses. Examination with an ophthalmoscope revealed a detached retina with what appeared to be a mass behind the retinal pigmented epithelium. A CAT scan of the orbit showed a tumor (a mass of tissue) filling about 1/4 of the posterior of the eye.

1. What is the most likely neoplastic diagnosis?

2. What is a possible non-neoplastic diagnosis?

3. Is there a non-invasive way to differentiate between these?

4. The patient had pigmentation of the retina and uvea, is there any significance in his race?

5. How might an ocular melanoma present?

6. If this is thought to be a melanoma, what treatment is he likely to receive?

7. What will the pathologist look for? If this is a uveal melanoma and it metastasizes, where is it likely to go and how? How does this differ from melanoma of the skin.

Case 3: Mole?

Clinical vignette:

This 40 year old white female had an 8 mm slightly raised "mole" on her shoulder which she thought was no big deal. However, during a routine physical examination, a physician noted that there was a flat pigmented portion extending from one side of this mole like comet with a crooked tail.

1. What is the most likely diagnosis and what should be done to confirm this?
2. What part of the physical exam becomes very important?
3. On histologic examination, what are the possible findings and what prognosis goes with each of these?
4. What treatment needs to be done?

Case 4: Erythematous Plaques

Clinical vignette:

This 20 year old male presented to his dermatologist because of the appearance over his arms and trunk of multiple slightly rased erythematous plaques covered with a whitish scale. No fungus was found in scrapings of the lesions which bled when lightly scraped. A biopsy was done and on examination uniform, long, thin, finger-like extensions of the rete ridges and dermal papillae was found. This were topped with a parakeratotic scale containing focal clusters of neutrophils. The dermal papillae contained prominent capillaries, neutrophils and lymphocytes.

1. What is this patient's skin disease?
2. What is its clinical course likely to be?
3. What other organs or tissues might be involved in this disease?
4. What is the malignant potential of this disease?