Clinical Reader

This activity reviews the optics (mainly refractivity) of the human eye. The functional principles of refractive correction and emmetropization are also discussed. For conditions that can cause variability or unspecificity of cylindrical (chiefly axis) refinement or in patients that do not tolerate toric corrections, spherical equivalent prescriptions can provide an adequate alternative when dispensing corrective lenses. The indications, contraindications, and methods of determining the spherica

A prism is a wedge-shaped glass piece made up of transparent material. They have the property of a light ray's deflection towards the base. Prisms are routinely used in orthoptic practice to assess the degree of squint and manage deviations so that the eye becomes orthotropic. Prisms have been used in ophthalmology to treat binocular pathologies for over 100 years. However, only after the 1950s did instrumental orthoptics not provide the desired results; pediatric ophthalmologists started using

The Haidinger brush phenomenon, also known as Haidinger brushes, is a distinctive and intriguing visual phenomenon that allows humans to perceive the polarization of light. This entoptic phenomenon is named after Austrian scientist Wilhelm Karl von Haidinger, who first reported the phenomenon in 1844. The Haidinger brush phenomenon is an elliptical, yellowish-blue pattern against a blue or white background when viewing polarized light. The visualization of Haidinger brushes is a way of observing

Aflibercept is an anti-vascular endothelial growth factor (VEGF) medication approved for the treatment and management of neovascular (wet) age-related macular degeneration (nAMD), diabetic macular edema, macular edema secondary to retinal vein occlusion, diabetic retinopathy, and retinopathy of prematurity. Aflibercept is a humanized recombinant fusion protein that functions as a soluble decoy for VEGF receptors, also known as "VEGF trap," which is designed to inhibit the predominant signaling p

Pityriasis lichenoides encompasses a group of inflammatory cutaneous disorders known as pityriasis lichenoides chronica (PLC), pityriasis lichenoides et varioliformis acuta (PLEVA), and febrile ulceronecrotic Mucha-Habermann disease (a subtype of PLEVA). PLEVA is a relatively benign cutaneous disorder of unclear origin that affects children and young adults. Patients present with a spontaneous eruption of erythematous macules that evolve into papules, rapidly undergoing hemorrhagic necrosis and

The medial patellofemoral ligament (MPFL) extends from the femur to the superomedial patella and is trapezoidal in shape. It plays a substantial role in stabilizing the medial aspect of the patella, especially in early flexion (0-30°). It restrains the patella and inhibits its lateral displacement. Injuries to the MPFL are rare but may occur in athletes during sporting accidents or during a traumatic event. If the patella is dislocated laterally, the MPFL is ruptured more than 90% of the time. P

Harlequin syndrome is a rare dysautonomic disorder characterized by unilateral impairment of facial sudomotor and vasomotor function due to disruption of sympathetic fibers, most commonly involving the T2 to T3 segments. Etiologies include injury, compression, or iatrogenic blockade along the sympathetic pathway extending from the hypothalamus to the face. However, approximately half of the reported cases are idiopathic. Recognized risk factors include cervical or upper thoracic surgery, regiona

Mild cognitive impairment (MCI) denotes memory changes that exceed the criteria for normal aging but do not meet the criteria for dementia. It is important to distinguish MCI from both normal aging and dementia, though it is categorized as a neurocognitive disorder (NCD). It can represent an early stage of dementia; however, other diseases can also cause MCI. Some causes of MCI can be easily treated if diagnosed early. Early detection of MCI can help maintain functional independence and prompt c

Distal clavicular osteolysis (DCO) is an overuse injury most often seen in athletes and weight lifters that causes pain in the AC joint. This is an atypical injury with multiple effective treatment modalities. Distal clavicular osteolysis results from repetitive excess load to the AC joint, typically through horizontal adduction, adduction, internal rotation, and forward/lateral flexion of the shoulder, such as bench pressing or overhead lifting. This activity reviews the evaluation and treatmen

Trivalent chromium is considered an essential trace element for metabolizing lipids and carbohydrates. Some clinical trials suggest that it enhances the effect of insulin in peripheral tissues. Trivalent chromium is believed to be an essential component of metalloenzymes in metabolizing carbohydrates, proteins, and fats. Therefore, it is a recommended component of a regular diet in most individuals and an essential supplement for those on total parenteral nutrition. However, there has been debat

Pulmonary veno-occlusive disease is a rare cause of group 1 pulmonary hypertension. It is characterized by having significant venous and capillary involvement, as opposed to other causes of group 1 pulmonary hypertension, in which the arteries are primarily involved. This disease has significant mortality, and early recognition remains paramount in its management. This activity reviews the evaluation and management of patients with pulmonary veno-occlusive disease and highlights the role of the

Corneal astigmatism occurs due to the inequality of the corneal curvatures and needs to be addressed to achieve spectacle independence and optimal vision. Corneal astigmatism can be calculated by corneal topography, corneal tomography, keratometry, and intraoperative aberrometry. Toric intraocular lenses (IOLs) are considered the most predictive way of correcting corneal astigmatism in a patient undergoing cataract surgery, as they may correct astigmatism as low as 0.75 diopters. Monofocal and m

Aphakia is the absence of the crystalline intraocular lens. Individuals may develop aphakia as a consequence of a rare genetic disorder, cataract development, or the dislocation of the natural lens. Subsequent refractive options to address aphakia are contingent on the patient's age, the condition's laterality, and the individual's binocular state. Eyecare providers must consider short- and long-term optical strategies to address the symptoms like blurred vision, loss of accommodation, and faded

Retinoscopy is an examination technique that permits objective measurement of the refractive error of the eye. The information gleaned from retinoscopy can help determine the best-corrected visual acuity and may be applied to subjective refraction techniques. Retinoscopy can also provide qualitative data on various underlying ocular pathologies, including cataracts, corneal ectasia, and retinoblastoma. Retinoscopy requires provider training but very little equipment; once proficient, the skilled

The most common cause of visual disability worldwide is refractive errors, and their prompt diagnosis and timely treatment are essential in preventing irreversible visual sequelae, such as amblyopia. Refraction can be divided into cycloplegic and non-cycloplegic. Cycloplegic refraction is the gold standard investigation in children and adults with active accommodation as it paralyzes ciliary muscle and prevents over minus correction because of the accommodative component. The disadvantage can be

Lifestyle medicine is the evidence-based practice of helping patients adopt and sustain behaviors that promote health and improve quality of life. Lifestyle medicine emphasizes six pillars of healthy habits: nutrition, exercise, relationships, stress, sleep, and substance use. Combined, these habits become a risk or protective factor for each person's physical and mental health and can also be modified to improve quality of life. This activity reviews the relationship between emotional distress

Regular physical activity is essential for maintaining good health and quality of life. Physical activity benefits everyone regardless of age, fitness level, or underlying clinical conditions. Physical activity is linked with positive health outcomes that accumulate immediately after initiating physical activity; however, most Americans do not meet the current aerobic and muscle-strengthening exercise guidelines. This lack of physical activity is associated with decreased quality of life, increa

A prism is a triangular refracting surface with an apex and a base. The incident light ray passing through the prism is refracted so that it is bent towards the base. Thus the image is shifted towards the apex. The amount of light refracted through the prism depends on the power of the prism defined in prism diopters. Prisms play an essential role in orthoptics and are invaluable in an ophthalmologist's clinic as they have definitive optical, therapeutic, and diagnostic uses. Prisms are used in

Acute musculoskeletal pain is 1 of the most prevalent complaints in inpatient and outpatient settings. Many patients receive pharmacologic treatment for these complaints. Osteopathic manipulative treatment (OMT) allows providers to have another treatment option that is easily accessible. OMT involves manual manipulation of muscles and fascia to reduce pain and tension and help facilitate the body's restorative functions. Somatic dysfunction is defined as an imbalance within the musculoskeletal s

Dizziness as a patient complaint can refer to many different sensations, including lightheadedness, vertigo, or unsteadiness. Dizziness is a common presenting complaint in ambulatory and emergency room settings and often progresses to inpatient care. It has commonly been separated into categories: vertigo, presyncope, lightheadedness, and disequilibrium. Unfortunately, it is rarely clear-cut, and patients often have difficulty distinguishing their symptoms. This activity outlines the differentia

The cisterna magna is a cerebrospinal fluid (CSF) filled space located in the posterior fossa dorsal to the medulla and caudal to the cerebellum. Mega cisterna magna refers to a cystic posterior fossa malformation characterized by an enlarged cisterna magna, absence of hydrocephalus, and an intact cerebellar vermis. The concept of mega cisterna magna was first introduced in the 1960s by Gonsette; its size was initially described on ventriculography as above 15 mm in anteroposterior length, 5 mm

Teprotumumab is a newly approved medication to manage active, moderate to severe thyroid eye disease. Teprotumumab has been approved by the U.S. Food and Drug Administration (FDA) for treating thyroid orbitopathy, under breakthrough therapy designation, as an Orphan Drug. It is an insulin-like growth factor-1 receptor (IGF-1R) inhibitor in the class of biological therapy. This activity describes the indications and evidence supporting each indication, action, and contraindications for teprotumum

Superficial siderosis is a rare neurological disorder characterized by iron deposition in the superficial layers of the brain and spinal cord. This condition typically arises from chronic bleeding into the subarachnoid space, often due to previous head or spinal trauma, tumors, or vascular malformations. As iron accumulates over time, it damages nerve tissues, leading to a spectrum of symptoms ranging from progressive hearing loss and imbalance to cognitive decline and neurological deficits. Des

Renal infarction is a rare ischemic event caused by the complete or partial occlusion of the main renal artery or its segmental branches, ultimately leading to ischemic renal necrosis. Renal infarction most commonly occurs due to an embolus originating from the heart or an in situ thrombosis. The diagnosis of renal infarction should be considered in patients who develop sudden abdominal or flank pain with reduced renal function, elevated LDH, hematuria, or proteinuria and who do not have urolith

Pigment dispersion syndrome (PDS) is a common type of open-angle glaucoma which is relatively underdiagnosed. It is characterized by the spontaneous dispersion of pigment granules from the pigment epithelium of the iris, which gets deposited in the anterior segment. It is a bilateral condition that is more commonly encountered in myopic young males. Secondary pigment dispersion can be seen after ocular trauma, tumors of the iris, and rubbing the IOL against the surface of the iris. Secondary pig

Meibomian gland dysfunction encompasses various disorders affecting the meibomian glands, causing ocular discomfort, dry eyes, and visual disturbances. Factors like aging, digital device use, and hormonal changes contribute to its onset. Blocked meibomian ducts lead to reduced lipid secretion, tear film instability, and ocular surface inflammation. Diagnosis relies on outpatient tests and questionnaires to determine disease severity, guiding treatment decisions. Clinicians participating in this

This activity focuses on small interfering RNA (siRNA) therapy, exemplified by FDA-approved agents such as patisiran, givosiran, lumasiran, inclisiran, nedosiran, and vutrisiran. These therapies are pivotal in managing rare metabolic ailments, including hereditary transthyretin amyloidosis (hATTR), acute hepatic porphyria (AHP), primary hyperoxaluria type 1 (PH1), and lowering low-density lipoprotein cholesterol (LDL-C) in subjects with heterozygous familial hypercholesterolemia (HeFH) or clinic

Gastric point-of-care ultrasonography is a bedside diagnostic examination used to evaluate gastric contents before anesthesia induction and support individualized aspiration risk assessment. This activity reviews gastric anatomy, scanning techniques, interpretation of qualitative findings, and quantitative assessment of gastric volume in patients with uncertain fasting status or conditions associated with delayed gastric emptying. The existing practice gap is that clinicians may inconsistently i

Bertolotti syndrome is a congenital disorder leading to back pain associated due to a lumbosacral transitional vertebra (LSTV). It most frequently occurs via an articulation of the L5 vertebra transverse process(es) with the sacrum, leading to irregular spinal mobility and pain. This disorder affects up to 8% of the population and must be accurately diagnosed to be managed appropriately. This activity describes the evaluation and treatment of Bertolotti syndrome and reviews the role of the inter

Reentry describes a self-sustaining cardiac rhythm abnormality. In reentry, the action potential propagates in a circus-like closed loop manner. It is a disorder of impulse conduction and thus describes one kind of arrhythmogenesis and is differentiated from disorders of impulse generation such as automaticity and triggered activity. First studies investigating reentry are over 100 years old and go back to Mines and Garrey. Dysrhythmias based on the reentry mechanism include atrial tachyarrhythm

Exotropia is the most common type of strabismus reported worldwide. Intermittent exotropia is the most common subtype. Exotropia is defined as the outward deviation of either one or alternate eyes, which can be present intermittently or be persistent. The most common pattern of progression in exotropia is exophoria in the initial stages, progressing to intermittent exotropia and finally constant exotropia as the most advanced stage. This activity highlights the role of the interprofessional team

Esotropia, commonly referred to as an inward deviation of eyes, is a common clinical entity seen in the outpatient department. Esotropia may be congenital/acquired, constant/intermittent, unilateral/alternating. Clinical examination, pathophysiology, and predisposing factors are essential to understand and diagnose esotropia subtype and plan appropriate management. Congenital esotropia is the most common type of esodeviation seen in early childhood and commonly presents within the first six mont

Hearing loss in the elderly is an increasingly common condition, affecting millions worldwide. This condition has far-ranging impacts on individual health and wellbeing. The etiology of hearing loss in the elderly is broad and proper diagnosis is key in preventing morbidity. To properly diagnose and manage this condition, providers must understand the common causes of hearing loss in the elderly (including sensorineural, conductive, and mixed losses) and the appropriate workup for each. Adequate

Otoacoustic emissions testing offers another modality of evaluation of the auditory system beyond conventional audiometry. It may be performed for patients with suspected hearing loss who cannot tolerate or complete conventional hearing tests. The testing does not require recording a patient's subjective response to sound. There are several different ways to measure otoacoustic emissions, each with advantages and disadvantages. This activity reviews the evaluation of hearing loss using otoacoust

Hearing loss is common in the United States, with approximately 13% of people over 12 years of age reported experiencing hearing loss in both ears on clinical testing. Therefore, it is vital that audiologists can accurately measure patients' hearing to help provide the best management for hearing loss. If a hearing loss is detected, it is also important to understand whether it is a conductive or sensorineural hearing loss, as both possible underlying pathophysiology and management options diffe

Hearing loss is a common condition that affects millions of people regardless of age, ethnicity, and health status. Appropriate treatment for hearing loss depends greatly on the underlying pathophysiology and the severity of the condition. Pure-tone audiometry is a critical means of obtaining diagnostic information to guide healthcare providers toward appropriate treatment. Appropriate treatment for hearing loss depends significantly on the pathophysiology and the severity of the condition, and

Cardiac syndrome X (CSX) is characterized by typical or atypical anginal chest pain with no evidence of significant coronary vascular abnormalities visualized on angiogram. It is viewed as a type of ischemic heart disease with occurrence most prevalent in perimenopausal and postmenopausal females. To avoid the high morbidity and complications associated with this condition requires prompt diagnosis and treatment. This activity reviews the evaluation and treatment of CSX and highlights the role o

Malignant eyelid lesions are a unique subset of cancers that range from some of the most common forms of cutaneous malignancy, such as basal cell and squamous cell carcinoma, to much rarer forms of metastatic disease. Many cases may resemble or arise from benign or premalignant lesions, necessitating a thorough history, careful examination, and prompt biopsy to ensure optimal patient outcomes. This course discussion focuses on the broad concepts of eyelid malignancy, including etiology, epidemio

The hexokinase method is a diagnostic test that accurately measures glucose concentration in biological fluids. This method is commonly used to estimate plasma glucose levels and is highly accurate and robust. Measuring plasma glucose concentration is essential for assessing a patient's glycemic state, which can be helpful in various medical conditions, such as diabetes mellitus, stroke evaluation, and acute trauma. When other methods, such as blood-prick test, HbA1c, or oral glucose tolerance t

An osmometer is a device used in clinical laboratories for measuring the concentration of particles in a solution, known as the osmolar concentration. This quantity can be expressed as osmolality (in mmol/kg) or osmolarity (in mmol/L). Clinical laboratories typically measure osmolality, which is considered more precise as weight is temperature-independent. In laboratory analysis, a dissolved substance is referred to as a solute, and the substance in which the solute is dissolved is referred to a

The coronavirus disease 2019 (COVID-19) pandemic began in December 2019, and consequent to its many variants, 2 years later, the crisis continues. A droplet-borne virus with mutants displaying characteristics of rapid spread makes it necessary that individuals at risk of poor outcomes need all the affordable protection, education, and management resources. Though it is primarily a pulmonary disease, the extra-pulmonary manifestations and consequences of COVID-19 make it even more challenging to

The Kidd blood group system is a collection of glycoprotein antigens on the surface of red blood cells responsible for the urea transport and maintaining the osmolarity of red blood cells. This activity describes the role of the Kidd blood group system in improving the knowledge of clinicians, researchers, technicians, and other healthcare providers dealing with transfusion-related activities. This activity empowers healthcare professionals to understand the basic genetics of the SLC14A1 gene, t

Baclofen is a centrally acting muscle relaxant used to manage spasticity associated with various neurologic conditions, including multiple sclerosis, cerebral palsy, and spinal cord injury. Baclofen toxicity may result from overdose, accumulation in renal impairment, or withdrawal of intrathecal therapy and can be life-threatening. Clinical manifestations range from somnolence, hypotonia, and respiratory depression to seizures, coma, and cardiovascular instability. Diagnosis is primarily clinica

Bupropion toxicity is a potentially life-threatening condition requiring rapid recognition and coordinated management, particularly following overdose involving extended-release formulations that may cause delayed symptom onset and sudden clinical deterioration. Neurologic and cardiovascular complications can include agitation, tachycardia, conduction abnormalities, delayed-onset seizures, status epilepticus, and death. This course reviews the epidemiology, clinical presentation, risk stratifica

Congenital pseudarthrosis of the tibia is a rare dysplastic pathological condition of the lower limbs leading to significant disability. The etiology of this condition is not clear, but an association has been seen with neurofibromatosis type 1. It may be seen at birth or manifest at the walking age with pathological fractures leading to deformity and limb length discrepancy. The treatment of this condition is mainly surgical, with various options aimed at achieving bone union, correcting limb d

Iridocorneal endothelial syndrome (ICE) is a rare condition characterized by the increased proliferation and migration of corneal endothelial cells to the iris and iridocorneal angle, leading to secondary angle-closure glaucoma, corneal edema, and atrophy of the iris. ICE is a group of disorders with three clinically distinct variants, including essential iris atrophy (EIA), Chandler syndrome (CS), and Cogan-Reese syndrome (CRS). If left untreated, each variant may progress to blindness. However

Retrobulbar hematoma is the phenomenon of blood collecting in the retrobulbar space behind the globe. Although not common, it is a serious condition that can lead to blindness. This activity reviews the evaluation and management of retrobulbar hematoma and highlights the role of the interprofessional team in improving care for patients with this condition. Objectives: Determine the etiology of retrobulbar hematoma. Identify the pathophysiology of retrobulbar hematoma. Assess the typical presenta

Pyogenic flexor tenosynovitis is a surgical emergency involving bacterial infection of the digital flexor tendon sheath. Delayed recognition can lead to tendon necrosis, adhesions, digital stiffness, horseshoe abscess formation, ischemia, amputation, and permanent functional impairment. This continuing medical education activity reviews flexor tendon sheath anatomy, routes of infection, causative organisms, Kanavel signs, diagnostic imaging, laboratory evaluation, staging, nonoperative treatment

Dysarthria is a neuromotor speech disorder caused by impaired coordination, strength, or control of the respiratory, phonatory, resonatory, articulatory, and prosodic subsystems, resulting in reduced speech intelligibility despite preserved language formulation. This activity reviews the etiologies of this condition, which arises from diverse neurologic and nonneurologic pathologies across the neuroaxis, including stroke, neurodegenerative disease, demyelinating conditions, trauma, and neuromusc

Noninvasive positive pressure ventilation is an intervention that delivers pressurized gas to the lungs via an external interface, augmenting alveolar ventilation and reducing the work of breathing without endotracheal intubation. Indications include acute and chronic respiratory failure, particularly cases with hypercapnic and cardiogenic etiologies. Contraindications include impaired airway protection, hemodynamic instability, and facial trauma. Advantages over intubation include reduced risk

Bone metastasis is a common occurrence in many cancers, frequently leading to debilitating symptoms such as pain, pathologic fractures, and compromised quality of life, with the spine being the most frequent site of tumor seeding. With advancements in systemic therapies prolonging the life expectancy of cancer patients, the demand for effective pain relief and functional improvement through palliative radiation therapy for bone metastases has significantly increased. This surge in demand has led

The sorbitol or polyol pathway is a two-step metabolic pathway that converts glucose into fructose. This pathway is thought to play a prominent role in explaining the pathogenesis of complications in patients with end-stage diabetes. In light of this, this activity presents the biochemistry behind this pathway, summarizes the individual reactions and their importance, reviews the prevailing hypothesis explaining why this pathway plays a role in end-stage diabetes, and explores the clinical signi

Indocyanine green angiography is an important invasive imaging modality among many diagnostic imaging modalities used in retinochoroidal diseases. It helps to study the anatomy, physiology, and pathology of choroidal and retinal circulation. It has an important role in the diagnosis of various ocular pathologies. This activity describes the anatomy of choroidal circulation and reviews the techniques and interpretation of indocyanine green angiography. It also highlights the role of the interprof

Posner-Schlossman syndrome (PSS), also known as glaucomatocyclitic crisis, is a rare cause of inflammatory ocular hypertension. Once thought to be benign, PSS is now known to be associated with significant ocular morbidity and loss of vision. The condition is characterized by recurrent episodes of uniocular rise in intraocular pressure (IOP) that are out of proportion with minimal intraocular inflammation. Cytomegalovirus infection of the anterior chamber may also be associated with this disease

Bimatoprost ophthalmic solution is a medication that addresses medical and cosmetic concerns. This activity discusses this eye drop's chemical intricacies, pharmacodynamics, and pharmacokinetics, shedding light on its therapeutic role in reducing intraocular pressure (IOP) among patients with primary open-angle glaucoma (POAG) and ocular hypertension. This prostaglandin (PG) F2 alpha analog exerts its influence by activating bimatoprost-sensitive receptors scattered across various ocular structu

Vascular anomalies of the orbit represent a heterogeneous group of vascular lesions found within the orbit. A profound understanding of the natural course, appropriate nomenclature, clinical features, and imaging characteristics is essential for accurate diagnosis and appropriate management. This activity reviews the recently laid-out guidelines by the International Society for the Study of Vascular Anomalies (ISSVA) and describes the evaluation and management of OVAs. It also highlights the rol

Fundus fluorescein angiography (FFA) is an invasive diagnostic procedure. It helps to assess the anatomy, physiology, and pathology of retinal and choroidal circulation. It aids in the diagnosis of various ocular pathologies. It contributes to decision-making when planning the management of ocular pathology. It is also useful as a teaching tool. Although it is a safe procedure, there are adverse effects associated with it. This activity outlines the basic principles, techniques, and interpretati

Lacrimal gland masses can arise from many etiologies, including neoplastic and non-neoplastic causes. Of the neoplastic causes, the malignant tumors generally have a poor prognosis and thus are treated aggressively. This usually involves a combination of extensive surgical resection (often orbital exenteration), radiation, and chemotherapy. The most notable exception is orbital lymphoma, which is not treated surgically. Recent developments in treatment strategies involving intra-arterial chemoth

Preeclampsia is a disorder that affects pregnant women, most commonly in their third trimester. Characterized by hypertension and proteinuria, it can involve nearly every organ system and often results in significant end-organ dysfunction. Preeclampsia is relatively common in pregnancy, affecting between 3% and 8% of pregnancies worldwide. Visual symptoms occur in up to 40% of affected patients, and the condition can affect multiple parts of the visual pathway. Although the numerous changes that

Optic nerve drusen are refractive, calcified nodules located within the optic nerve head. Optic nerve drusen can be mistaken for unilateral or bilateral disc edema and are often a source of diagnostic confusion. Although typically benign entities, optic nerve drusen can cause visual field defects and are associated with conditions that cause vision loss, such as central retinal artery occlusion and ischemic optic neuropathy. It is crucial to appropriately work up and follow this condition to est

Oculocerebrorenal syndrome, or Lowe syndrome, is a rare X-linked recessive disorder caused by pathogenic variants in the OCRL gene, leading to disruption of phosphoinositide metabolism and widespread cellular dysfunction. This course reviews this condition, which affects multiple organ systems, producing a characteristic triad of congenital cataracts, intellectual disability, and proximal renal tubular dysfunction, as well as the neurological manifestations of oculocerebrorenal syndrome, includi

Retinal pattern dystrophies represent several diseases that involve a variety of patterns of pigment deposition in the retinal pigment epithelium (RPE) of the macula. Given the RPE's critical role in waste removal, many pattern dystrophies feature waste accumulation primarily of lipofuscin. Typically, these dystrophies are associated with a good visual prognosis; however, there remains a risk for progressive central vision loss. Pattern dystrophies are usually inherited, often presenting in the

Cyclodiode laser has traditionally been used to treat high intraocular pressures and refractory cases of glaucoma not amenable to medical or other surgical options. The cyclodiode laser ablates the ciliary processes, reducing aqueous humor formation and lowering the intraocular pressure. The development and advancement in cyclodiode laser delivery devices have expanded treatment options for varying glaucoma subtypes. This activity reviews the background of cyclodiode laser as a treatment for gla

Endogenous endophthalmitis is a rare and dreaded ophthalmic emergency that usually results in vision-threatening sequelae. The diagnosis is often a challenge for all ophthalmologists and vitreoretinal surgeons and is generally secondary to underlying secondary systemic pathology. In a few cases, sometimes the cause may not be identified. It can manifest at any age and has varied predisposing risk factors. The etiology is multifactorial with a broad spectrum of microorganisms. Medical or surgical

Normal-tension glaucoma is a characteristic glaucomatous optic neuropathy with intraocular pressures in the normal range. It is a common condition and can lead to bilateral blindness. Monitoring and treatment can reduce the risk of visual morbidity in most patients. This activity reviews the evaluation and management of normal-tension glaucoma and highlights the role of the interprofessional team in evaluating and treating patients with this condition. Objectives: Identify the risk factors for d

This activity describes the evaluations, diagnosis, and management of pigment dispersion syndrome (PDS) and pigmentary glaucoma (PG). It describes the important clinical signs and symptoms in patients at risk and how to follow patients over time. To avoid irreversible glaucomatous optic neuropathy and visual field progression, periodic examinations are of utmost importance for patients with this condition. Management and early diagnosis should include slit-lamp examinations, tonometry, gonioscop

Pseudoexfoliation syndrome is a chronic, age-related disorder of the extracellular matrix that results in the deposition of abnormal fibrillary (pseudoexfoliative) material within various body tissues. This condition manifests primarily in the anterior segment of the eye. Individuals with this condition can develop pseudoexfoliation glaucoma in the presence of chronic elevated intraocular pressure, glaucomatous optic neuropathy, and visual field damage. This activity reviews the evaluation and t

Intraocular foreign body (IOFB) is an accidental injury usually resulting from chisel hammering and firearm use. It is a serious ocular condition that can potentially cause permanent vision loss. To avoid the high morbidity associated with this condition, it must be promptly diagnosed and treated. This activity reviews the evaluation and treatment of an IOFB and highlights the role of the interprofessional team in evaluating and treating patients with this condition. Objectives: Explain the path

Pyocystis is a severe form of lower urinary tract infection that results from the collection of purulent debris within the bladder. Pyocystis is sometimes referred to in the literature as ‘empyema cystis’ and ‘vesical empyema.’ Pyocystis is an uncommon condition that occurs exclusively in the defunctionalized bladder. It can cause a severe systemic infection and result in prolonged hospital stays, surgery, and death. To optimize outcomes and reduce morbidity, early identification and treatment m

Alternobaric facial paresis (AFP), also known as facial baroparesis, baroparesis facialis, or alternobaric facial nerve palsy, is a rare and usually transient neurapraxia affecting the seventh cranial nerve (CNVII, the facial nerve) due to pressure-related effects in the tympanic cavity. This condition arises when pressure in the middle ear compresses the facial nerve against the cochlear promontory, in the medial wall of the tympanic cavity, resulting in symptoms resembling Bell's palsy. AFP is

Factor V deficiency is a rare bleeding disorder that can be inherited or acquired. Factor V is a vital component of the coagulation cascade, a glycoprotein synthesized primarily in the liver and released in the bloodstream in an inactive form. Blood vessel injury activates blood clotting factors, including factor V. Activated factor V ultimately accelerates fibrinogen conversion to fibrin, the protein meshwork that reinforces the clot. Factor V deficiency disrupts this intricate clotting mechani

A sesamoid bone is a small bone commonly found embedded within a muscle or tendon near joint surfaces, existing as focal areas of ossification and functioning as a pulley to alleviate stress on that particular muscle or tendon. Unlike standard bones, which connect via joints, sesamoid bones connect to muscles via tendons. The word sesamoid derives from the Arabic word 'sesamum' translating to sesame, given that many sesamoid bones are small. Sesamoid bones are most commonly located in the foot,

The human tongue is an organ that aids the process of digestion by facilitating the manipulation and movement of food particles during mastication and swallowing. The tongue is also vital in the production of speech and essential for employing the sense of taste. The styloglossus muscle is a paired extrinsic muscle of the tongue. It coordinates with the other extrinsic muscles of the tongue, including the hyoglossus muscle, the genioglossus muscle, and the palatoglossus muscle, to produce the va

Sarcocystosis is an infection caused by the intracellular protozoan parasites of the Sarcocystis species, with a global distribution but sporadic occurrence in humans. Most human infections are asymptomatic and typically discovered incidentally, making it a relatively rare condition. The parasite can be contracted by consuming undercooked meat or contaminated food and water. When symptomatic, sarcocystosis may present with gastrointestinal or muscular symptoms. Due to the challenges in diagnosin

Tafamidis is an oral medication for treating cardiomyopathy and peripheral neuropathy due to transthyretin amyloidosis (ATTR). It is a transthyretin stabilizer and has been shown to reduce disease progression and mortality significantly. This activity will highlight the current indications, mechanism of action, dosage, contraindications, and other key factors (e.g., off-label uses, dosing, pharmacodynamics, pharmacokinetics, monitoring, relevant interactions) of tafamidis in a clinical setting p

Aducanumab was the first amyloid-β-directed monoclonal antibody to receive accelerated approval from the FDA for Alzheimer disease, marking a pivotal development in disease-modifying therapy and informing the regulatory and clinical evaluation of subsequent anti-amyloid agents. Although its development was discontinued in 2024 and the medication is no longer available for new treatment initiation, its clinical experience remains relevant to understanding patient selection, amyloid confirmation,

Phlebotomy describes the act of removing blood from a patient using a needle. This can be for the purposes of laboratory testing as a diagnostic tool to narrow down a differential or can be used therapeutically for certain conditions. This activity reviews the procedure of phlebotomy and its various clinical correlations. Objectives: Review the common anatomical locations for phlebotomy. Identify the indications for phlebotomy as a diagnostic tool. Summarize the indications for therapeutic phleb

Neuronal brain tumors are a diverse group of primary central nervous system tumors consisting of lesions with either a primarily neuronal background or a mixed glial and neuronal background, termed glioneuronal tumors. These are rare tumors most commonly associated with epilepsy, although other symptoms may also occur, such as headaches, focal neurological deficits, and acute hydrocephalus. This activity reviews the evaluation and treatment of neuronal brain tumors. It highlights the role of the

The cerebrospinal fluid (CSF) is a nourishing and protective layer surrounding the central nervous system (CNS). This protective cushion circulates within the ventricular system and the subarachnoid space around the brain and the spinal cord, which helps to provide the buoyancy to counteract various shears and stresses encountered during the movement of the skull and vertebral column. In various disorders that present with CSF leak, the loss of this protective nutrient-rich layer can injure the

Metatarsal fractures are one of the most common foot injuries encountered in trauma and emergency. They usually occur as a result of direct trauma to the forefoot. The common presentation involves foot pain and swelling with difficulty in ambulating without support. The treatment involves conservative management in the form of cast or operative treatment in selected cases. This activity reviews the evaluation and management of metatarsal fractures and highlights the role of the interprofessional

Primary ovarian insufficiency (POI) is a disease that affects women less than 40 years of age. Commonly, women present with amenorrhea for 4-6 months, low estradiol levels, and elevated follicle-stimulating hormone (FSH) level. POI affects mental health, fertility, cardiovascular health, and bone health. This article outlines the evaluation, diagnosis, treatment, and management of primary ovarian insufficiency. In addition, it reviews the role of the interprofessional team in managing and improv

The maternal-fetal interface is a unique immunological environment that balances fetal tolerance with immune protection and protects both the mother and fetus from infections while preventing the immune rejection of the genetically distinct fetus. This specialized interface, centered around the placenta and involving the decidua, facilitates close interaction between maternal and fetal immune systems. This ensures proper embryonic development while defending against infections, thereby serving a

Male infertility contributes to approximately 50% of infertility cases, making comprehensive evaluation of male factors essential when assessing couples experiencing difficulty conceiving. This course reviews azoospermia, defined as complete absence of spermatozoa in 2 separate centrifuged semen specimens, which represents the most severe form of male infertility and affects approximately 1% of men and 10% to 15% of infertile males. This activity examines the evaluation and management of obstruc

Castleman disease is a lymphoproliferative disorder with a nondefinite etiology and can be classified into subtypes based on clinical and histological manifestations. Therefore, this condition's high morbidity and complications can be avoided with early diagnosis and prompt treatment. This activity explains the evaluation and treatment of Castleman disease and highlights the role of the interprofessional team in evaluating and treating patients with this condition. Objectives: Describe the patho

Mycetoma is characterized by a progressive and chronic granulomatous infection affecting the skin and subcutaneous tissue. Mycetoma can be classified as "eumycetoma" when it is caused by fungi or "actinomycetoma" when caused by bacteria in the order Actinomycetes. Therefore, eumycetoma is a deep fungal infection of the skin and subcutaneous tissue commonly caused by the filamentous fungi Madurella mycetomatis . Eumycetoma is characterized by a deep granulomatous inflammation, resulting in the fo

This activity offers an in-depth examination of upadacitinib, a second-generation selective Janus kinase (JAK) inhibitor targeting the JAK1 enzyme, approved by the FDA for treating various chronic inflammatory conditions such as moderate to severe rheumatoid arthritis (RA), psoriatic arthritis, atopic dermatitis, ankylosing spondylitis, Crohn disease, and ulcerative colitis. The session will cover the specific mechanism by which upadacitinib inhibits key intracellular cytoplasmic enzymes (Janus

Sitosterolemia, increasingly called Phytosterolemia or Xenosterolemia, is an inherited condition that can lead to premature heart disease and other complications. It is characterized by excess accumulation of plant sterols in the blood. Once clinically recognized, it can be diagnosed with laboratory testing and treated with a combination of medications and lifestyle modification. Objectives: Outline the etiology of sitosterolemia. Review clinical signs which can help physicians identify sitoster

Extracorporeal membrane oxygenation (ECMO) is a well-known means of advanced life support in patients with significant cardiorespiratory impairment refractory to conventional therapeutic interventions. It is a salvage rescue therapy that can result in negative consequences if utilized by unfamiliar personnel. Nevertheless, there is a niche of critically ill children that will benefit from ECMO, and it is vital to appropriately select candidates to avoid or overcome complications and ethical dile

Stiff person syndrome (SPS) is a rare progressive and often underdiagnosed immune-mediated disorder of the central nervous system characterized by progressive rigidity and triggered painful spasms of predominantly axial and proximal limb muscles. The condition has an insidious onset with gradual worsening over time and, if left untreated, can lead to permanent disability and mortality. This activity reviews the evaluation and treatment of patients with SPS and emphasizes the importance of the in

Atypical antipsychotic use in psychiatric patients, particularly children and adolescents (C/A), has increased recently. Autism spectrum, bipolar, psychosis, and other psychiatric or emotional disorders are psychiatric conditions that need Antipsychotics today. There is limited data on the long-term safety of Antipsychotics on growth and development, specifically on bone metabolism. This activity outlines the clinical presentation, evaluation, and management by an interprofessional team of atypi

This activity reviews orthopedic prosthetics that are currently used in practice. It discusses both lower limb and upper limb prostheses and the different devices that make up their componentry. Also discussed are the complications associated with prosthetic devices and emerging advances in technology. This activity also highlights the critical role of the interprofessional team in caring for patients with prostheses. Objectives: Explain the different components of lower limb prostheses. Describ

Human immunodeficiency virus (HIV)-2 is an enveloped retrovirus causing human infection, similar to HIV-1, and is primarily endemic to West Africa. Due to globalization and increased migration, HIV-2 has now spread worldwide, with an estimated 1 to 2 million individuals affected. Without treatment, HIV-2 results in significant morbidity and mortality. Clinicians must recognize the distinctions between HIV-1 and HIV-2, particularly in individuals from high-prevalence regions, as prompt diagnosis

Chronic axial low back pain associated with vertebral endplate damage is an important and often underrecognized cause of persistent pain, disability, opioid exposure, and healthcare utilization. Basivertebral nerve ablation is a minimally invasive intervention for carefully selected patients with vertebrogenic pain, particularly those with Modic type 1 or type 2 changes on magnetic resonance imaging and symptoms refractory to conservative care. A persistent practice gap exists in clinicians' fai

This activity examines the wide-ranging applications of tocilizumab, a humanized monoclonal antibody approved by the FDA for managing rheumatoid arthritis (RA), giant cell arteritis (GCA), polyarticular juvenile idiopathic arthritis (PJIA), systemic juvenile idiopathic arthritis (SJIA), and COVID-19 pneumonia. The program elucidates the intricate mechanisms of action underlying tocilizumab's efficacy, detailing its authorized uses across diverse patient populations. Emphasis is placed on the int

Exercise-associated hyponatremia (EAH) is defined as a serum sodium level below 135 mmol/L that develops during or up to 24 hours after physical activity. This activity reviews the epidemiology, pathophysiology, evaluation, management, and prevention of exercise-associated hyponatremia (EAH) and the role of the interprofessional team and athletic event staff in recognizing, managing, and educating athletes with this condition. Objectives: Describe the epidemiology and pathophysiology of EAH. Out

This article is made available for historical review, monoclonal antibody use is not currently indicated for this condition. COVID-19 illness is a clinical syndrome caused by a SARS-CoV-2 infection. It was first reported in Wuhan, China, in December 2019 and quickly spread to a pandemic level in 2020. A meta-analysis report stated that an estimated 18.2 million people died globally because of the COVID-19 pandemic between Jan 1, 2020, and the end of December 2021. SARS-CoV-2 or severe acute resp

This article is made available for historical review, monoclonal antibody use is not currently indicated for this condition. Coronavirus disease 2019 (COVID-19), the illness caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has had a devastating effect on public health and the world economy. SARS-CoV-2 primarily affects the respiratory system, with the majority of transmission occurring from close contact with presymptomatic, asymptomatic, or symptomatic carriers. Since the

Modern-day medicine has been revolutionized to be personalized and specific based on individualized specific disease characteristics. Monoclonal antibodies (mAbs) are a prime example of personalized therapeutics enabled by advances in our knowledge of immunology, molecular biology, and biochemistry. As an example, a disease such as cancer can be evaluated for the presence of certain properties (i.e., hormone receptors in breast cancers), which can, in turn, be targeted by mAbs to provide a "tail

Bamlanivimab is an investigational drug developed for COVID-19 pneumonia. It is in the class of neutralizing monoclonal antibodies. This activity illustrates the indications, action, and contraindications for bamlanivimab as a novel agent in the treatment and post-exposure prophylaxis of COVID-19. It will highlight the mechanism of action, adverse events, monitoring, and relevant interactions pertinent to the healthcare team in managing patients with COVID-19, especially in an ambulatory setting

As of January 24, 2022, the United States Food and Drug Associated (FDA) fact sheet for the drug etesevimab states that "due to the high frequency of the Omicron variant, bamlanivimab and etesevimab, administered together, are not currently authorized for use in any U.S. region because of markedly reduced activity against the Omicron variant. These drugs may not be administered for treatment or post-exposure prevention of COVID-19 under the Emergency Use Authorization until further notice by the